Provider Demographics
NPI:1255731642
Name:SPENCER, SHAMIEKA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHAMIEKA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TRYON PALACE ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1925
Mailing Address - Country:US
Mailing Address - Phone:910-922-5034
Mailing Address - Fax:
Practice Address - Street 1:7732 WEATHERED OAK WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6837
Practice Address - Country:US
Practice Address - Phone:910-922-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2108225800000X
NCC0165671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist