Provider Demographics
NPI:1568557197
Name:SPRUILL, MARTHA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
Last Name:SPRUILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MONUMENT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1452
Mailing Address - Country:US
Mailing Address - Phone:804-405-0939
Mailing Address - Fax:
Practice Address - Street 1:5500 MONUMENT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1452
Practice Address - Country:US
Practice Address - Phone:804-405-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical