Provider Demographics
NPI:1679842918
Name:SPENCER, NICOLE CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:CHRISTINE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-5787
Mailing Address - Country:US
Mailing Address - Phone:843-639-8039
Mailing Address - Fax:843-383-4625
Practice Address - Street 1:900 S 4TH ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-5787
Practice Address - Country:US
Practice Address - Phone:843-332-4141
Practice Address - Fax:843-383-4625
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC301100Medicaid
SC301100Medicaid