Provider Demographics
NPI:1952501785
Name:SPENCER, LORRIE G (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:LORRIE
Middle Name:G
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WESTBURY PARK WAY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8825
Mailing Address - Country:US
Mailing Address - Phone:843-757-0231
Mailing Address - Fax:
Practice Address - Street 1:28 WESTBURY PARK WAY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8825
Practice Address - Country:US
Practice Address - Phone:843-757-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEEXE6543Medicaid