Provider Demographics
NPI:1013159169
Name:SPENCER, WANDA LYNN (EDS)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:DENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 1ST AVE SW
Mailing Address - Street 2:SUITE 202 C
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398
Mailing Address - Country:US
Mailing Address - Phone:931-636-7411
Mailing Address - Fax:
Practice Address - Street 1:100 1ST AVE SW
Practice Address - Street 2:SUITE 202 C
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398
Practice Address - Country:US
Practice Address - Phone:931-361-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health