Provider Demographics
NPI:1265928030
Name:SPOMER, ALICIA BIANCA (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:BIANCA
Last Name:SPOMER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 GRELOT ROAD
Mailing Address - Street 2:STE G #51133
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3602
Mailing Address - Country:US
Mailing Address - Phone:602-633-5666
Mailing Address - Fax:
Practice Address - Street 1:6300 GRELOT RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3602
Practice Address - Country:US
Practice Address - Phone:602-633-5666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21335101YM0800X
AL4223101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-21335OtherARIZONA STATE BOARD OF BEHAVIORAL HEALTH EXAMINERS
AL4223OtherALABAMA BOARD OF EXAMINERS IN COUNSELING LICENSED PROFESSIONAL COUNSELOR LICENSE