Provider Demographics
NPI:1194081778
Name:SPENCER, DEBORAH JEAN (LLPC, RN)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEAN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LLPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52986 CHAMBERLAIN RD
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:MI
Mailing Address - Zip Code:49067-9325
Mailing Address - Country:US
Mailing Address - Phone:269-646-2191
Mailing Address - Fax:
Practice Address - Street 1:52986 CHAMBERLAIN RD
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:MI
Practice Address - Zip Code:49067-9325
Practice Address - Country:US
Practice Address - Phone:269-646-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012991101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor