Provider Demographics
NPI:1689221525
Name:SPENCE CLINICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SPENCE CLINICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS, LCAS, CCS
Authorized Official - Phone:704-621-7154
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-0264
Mailing Address - Country:US
Mailing Address - Phone:704-621-7154
Mailing Address - Fax:
Practice Address - Street 1:100 FOX GLOVE DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3630
Practice Address - Country:US
Practice Address - Phone:704-621-7154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty