Provider Demographics
NPI:1275363947
Name:SPENCER, SEAN MATTHEW (MA)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MATTHEW
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DOVERCREST CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-8314
Mailing Address - Country:US
Mailing Address - Phone:434-770-1886
Mailing Address - Fax:
Practice Address - Street 1:1437 MILITARY CUTOFF RD STE 210
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-3638
Practice Address - Country:US
Practice Address - Phone:910-444-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health