Provider Demographics
NPI:1215689146
Name:SPICER, LOIS J (SUDPT)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:J
Last Name:SPICER
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 E HIGHWAY 101 STE 3
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-9069
Mailing Address - Country:US
Mailing Address - Phone:360-452-4062
Mailing Address - Fax:360-452-4189
Practice Address - Street 1:3430 E HIGHWAY 101 STE 3
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-9069
Practice Address - Country:US
Practice Address - Phone:360-452-4062
Practice Address - Fax:360-452-4189
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0405X
WA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021581OtherREFLECTIONS COUNSELING SERVICES GROUP