Provider Demographics
NPI:1356981161
Name:SPENCE, MARY A (BSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:SPENCE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HIDDEN CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5267
Mailing Address - Country:US
Mailing Address - Phone:478-397-6675
Mailing Address - Fax:
Practice Address - Street 1:137 HIDDEN CREEK CIR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5267
Practice Address - Country:US
Practice Address - Phone:478-397-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator