Provider Demographics
NPI:1457525727
Name:SPENCER, ADAM ANDREW (BCBA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:ANDREW
Last Name:SPENCER
Suffix:
Gender:M
Credentials:BCBA
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Other - First Name:
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Mailing Address - Street 1:2300 LAKEVIEW PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-9066
Mailing Address - Country:US
Mailing Address - Phone:678-694-1744
Mailing Address - Fax:678-530-1018
Practice Address - Street 1:2300 LAKEVIEW PKWY STE 700
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-9066
Practice Address - Country:US
Practice Address - Phone:678-694-1744
Practice Address - Fax:678-530-1018
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2446171000000X, 171000000X
GA1-05-2446103K00000X
NC1-05-2446103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
14213808OtherCAQH
NC3408205Medicaid