Provider Demographics
NPI:1811466089
Name:SPACEK, CHRISTY EVELYN
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:EVELYN
Last Name:SPACEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 HOUSEN DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6555
Mailing Address - Country:US
Mailing Address - Phone:443-375-0549
Mailing Address - Fax:
Practice Address - Street 1:37 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1236
Practice Address - Country:US
Practice Address - Phone:410-526-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-17
Last Update Date:2018-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6646101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health