Provider Demographics
NPI:1669137725
Name:SPELLICY, CHRISTOPHER DAVID (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:SPELLICY
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRENDAN WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3562
Mailing Address - Country:US
Mailing Address - Phone:864-658-4141
Mailing Address - Fax:
Practice Address - Street 1:15 BRENDAN WAY STE 120
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3562
Practice Address - Country:US
Practice Address - Phone:864-658-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016361163WP0808X, 363LP0808X
SC29090363LP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health