Provider Demographics
NPI:1710420765
Name:SPENCE, SHAKIRA
Entity Type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:SPENCE
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 1:913 EASTHAM CT
Mailing Address - Street 2:APT #14
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:913 EASTHAM CT
Practice Address - Street 2:APT #14
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1006
Practice Address - Country:US
Practice Address - Phone:347-513-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician