Provider Demographics
NPI:1558735589
Name:SPICER, JERODNEY (MS)
Entity Type:Individual
Prefix:
First Name:JERODNEY
Middle Name:
Last Name:SPICER
Suffix:
Gender:M
Credentials:MS
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 21069
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29221-1069
Mailing Address - Country:US
Mailing Address - Phone:803-896-7544
Mailing Address - Fax:
Practice Address - Street 1:1620 SHIVERS RD
Practice Address - Street 2:BUILDING 1018
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5429
Practice Address - Country:US
Practice Address - Phone:803-896-7544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist