Provider Demographics
NPI:1578995981
Name:SPIVEY, ANGIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:
Last Name:SPIVEY
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 1:500 NW DIXIE HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-1186
Mailing Address - Country:US
Mailing Address - Phone:720-432-2395
Mailing Address - Fax:
Practice Address - Street 1:500 NW DIXIE HIGHWAY
Practice Address - Street 2:STE 102
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-692-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099256861041C0700X
FLSW103021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW10302OtherSTATE LICENSE
COCSW.09925686OtherSTATE LICENSE