Provider Demographics
NPI:1508994468
Name:SPENCER, GREG D (CADC II)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:D
Last Name:SPENCER
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 BECKETT LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0405
Mailing Address - Country:US
Mailing Address - Phone:209-527-3474
Mailing Address - Fax:
Practice Address - Street 1:3104 BECKETT LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0405
Practice Address - Country:US
Practice Address - Phone:209-527-3474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3789097 CADC II101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)