Provider Demographics
NPI:1770238065
Name:SPELLS, HICYNTHIA D
Entity Type:Individual
Prefix:
First Name:HICYNTHIA
Middle Name:D
Last Name:SPELLS
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 1:413 E CAMEO LN
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7662
Mailing Address - Country:US
Mailing Address - Phone:919-522-8264
Mailing Address - Fax:
Practice Address - Street 1:413 E CAMEO LN
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7662
Practice Address - Country:US
Practice Address - Phone:919-522-8264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician