Provider Demographics
NPI:1952103293
Name:SPENCER, TRISTAN ROMON
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:ROMON
Last Name:SPENCER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 ACORN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27248-7906
Mailing Address - Country:US
Mailing Address - Phone:336-327-2306
Mailing Address - Fax:
Practice Address - Street 1:3040 ACORN RIDGE RD
Practice Address - Street 2:
Practice Address - City:FRANKLINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27248-7906
Practice Address - Country:US
Practice Address - Phone:336-327-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)