Provider Demographics
NPI:1982372579
Name:SPIVEY, RICHARD COOPER (AMFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:COOPER
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 LAKESIDE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5790
Mailing Address - Country:US
Mailing Address - Phone:478-238-9344
Mailing Address - Fax:
Practice Address - Street 1:6055 LAKESIDE COMMONS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5790
Practice Address - Country:US
Practice Address - Phone:478-238-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
GAAMFT000771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty