Provider Demographics
NPI:1255669842
Name:SPOONER, LAUREN CARR (PHD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:CARR
Last Name:SPOONER
Suffix:
Gender:F
Credentials:PHD
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 632
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-0632
Mailing Address - Country:US
Mailing Address - Phone:229-524-2644
Mailing Address - Fax:229-524-0072
Practice Address - Street 1:400 S TENNILLE AVE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1622
Practice Address - Country:US
Practice Address - Phone:229-524-0071
Practice Address - Fax:229-524-0072
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AL1782103T00000X
GAPSY003776103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL148432Medicaid
AL102I624405Medicare PIN