Provider Demographics
NPI:1780031526
Name:LAUREN C. SPOONER, LLC
Entity type:Organization
Organization Name:LAUREN C. SPOONER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:229-524-0071
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-0632
Mailing Address - Country:US
Mailing Address - Phone:229-524-0071
Mailing Address - Fax:229-524-0072
Practice Address - Street 1:400 S TENNILLE AVE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1622
Practice Address - Country:US
Practice Address - Phone:229-524-0071
Practice Address - Fax:229-524-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003776103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty