Provider Demographics
NPI:1710504774
Name:SPENCER, MAGEN MARIE (CDCI)
Entity Type:Individual
Prefix:
First Name:MAGEN
Middle Name:MARIE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:NENANA
Mailing Address - State:AK
Mailing Address - Zip Code:99760-0159
Mailing Address - Country:US
Mailing Address - Phone:907-832-5557
Mailing Address - Fax:
Practice Address - Street 1:410 RIVER FRONT STREET
Practice Address - Street 2:
Practice Address - City:NENANA
Practice Address - State:AK
Practice Address - Zip Code:99760-0159
Practice Address - Country:US
Practice Address - Phone:907-347-8093
Practice Address - Fax:907-832-5564
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)