Provider Demographics
NPI:1609207216
Name:SPELLMAN, DAVID A (RMHCI, RMFTI, NCC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SPELLMAN
Suffix:
Gender:M
Credentials:RMHCI, RMFTI, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 E GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5213
Mailing Address - Country:US
Mailing Address - Phone:386-624-2177
Mailing Address - Fax:
Practice Address - Street 1:265 E GRAVES AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-5213
Practice Address - Country:US
Practice Address - Phone:386-624-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-07
Last Update Date:2013-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH10859101YM0800X
FLIMT1858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist