Provider Demographics
NPI:1831444827
Name:SPENCER, ERICA MARIE (PC)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:MARIE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 LAKE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2621
Mailing Address - Country:US
Mailing Address - Phone:330-730-8692
Mailing Address - Fax:
Practice Address - Street 1:624 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1017
Practice Address - Country:US
Practice Address - Phone:330-454-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional