Provider Demographics
NPI:1821188665
Name:SPENCER, MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCSW
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 9823
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80932-9823
Mailing Address - Country:US
Mailing Address - Phone:719-351-0727
Mailing Address - Fax:719-573-6709
Practice Address - Street 1:3812 E PIKES PEAK AVE
Practice Address - Street 2:SUITE - 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-7726
Practice Address - Country:US
Practice Address - Phone:719-351-0727
Practice Address - Fax:719-573-6709
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6472101YA0400X
COCSW9928191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)