Provider Demographics
NPI:1750649596
Name:SPANAKIS, NICOLE CHRYSANTHI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CHRYSANTHI
Last Name:SPANAKIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12778 N 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1878
Mailing Address - Country:US
Mailing Address - Phone:508-410-4746
Mailing Address - Fax:
Practice Address - Street 1:3240 E UNION HILLS DR STE 133
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-2629
Practice Address - Country:US
Practice Address - Phone:602-633-5474
Practice Address - Fax:602-733-6471
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005087103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical