Provider Demographics
NPI:1295259950
Name:GREY, VICTORIA SPENSER-NICHOLAS (LCSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SPENSER-NICHOLAS
Last Name:GREY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:SPENSER
Other - Middle Name:NICHOLAS
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2840 29TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1285
Mailing Address - Country:US
Mailing Address - Phone:720-365-4497
Mailing Address - Fax:
Practice Address - Street 1:2840 29TH ST APT 201
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1285
Practice Address - Country:US
Practice Address - Phone:720-365-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099275271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical