Provider Demographics
NPI:1477626836
Name:SPENCER, ERNESTINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:ERNESTINE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43644
Mailing Address - Street 2:SPENCER COUNSELING SERVICES, INC.
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-0042
Mailing Address - Country:US
Mailing Address - Phone:704-451-8769
Mailing Address - Fax:704-567-0189
Practice Address - Street 1:6500 ROCKSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-8059
Practice Address - Country:US
Practice Address - Phone:704-451-8769
Practice Address - Fax:704-567-0189
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5042101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103184Medicaid