Provider Demographics
NPI:1639867369
Name:SPENCER, KYNAZJA AMINI LASHAY
Entity Type:Individual
Prefix:
First Name:KYNAZJA
Middle Name:AMINI LASHAY
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 LOURANCE BLVD APT F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6069
Mailing Address - Country:US
Mailing Address - Phone:910-859-1462
Mailing Address - Fax:
Practice Address - Street 1:2505 LOURANCE BLVD APT F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6069
Practice Address - Country:US
Practice Address - Phone:910-859-1462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician