Provider Demographics
NPI:1659575199
Name:SPENCER, TERRY LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:SPENCER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 13TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2906
Mailing Address - Country:US
Mailing Address - Phone:828-327-2534
Mailing Address - Fax:
Practice Address - Street 1:2132 13TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2906
Practice Address - Country:US
Practice Address - Phone:828-327-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0051061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106058Medicaid
NC2871578Medicare ID - Type Unspecified