Provider Demographics
NPI:1215062781
Name:SPIVEY, CLAYTON ELIZABETH (LAC,MAC, DIPLAC)
Entity type:Individual
Prefix:MS
First Name:CLAYTON
Middle Name:ELIZABETH
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:LAC,MAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 OLD MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2640
Mailing Address - Country:US
Mailing Address - Phone:410-799-5883
Mailing Address - Fax:410-799-5886
Practice Address - Street 1:8342 OLD MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2640
Practice Address - Country:US
Practice Address - Phone:410-799-5883
Practice Address - Fax:410-799-5886
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU-411171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU-411OtherLICENSE