Provider Demographics
NPI:1518937861
Name:SPENCER, SUSAN SHACKELFORD (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SHACKELFORD
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:SHACKELFORD
Other - Last Name:ENDERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:365 CHAFFIN RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2351
Mailing Address - Country:US
Mailing Address - Phone:678-373-3428
Mailing Address - Fax:
Practice Address - Street 1:365 CHAFFIN RIDGE CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2351
Practice Address - Country:US
Practice Address - Phone:678-373-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038364-11041C0700X
GACSW0038721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical