Provider Demographics
NPI:1306112610
Name:SPICER, REGINA R (LSW, LICDC-CS)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:R
Last Name:SPICER
Suffix:
Gender:F
Credentials:LSW, LICDC-CS
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:R
Other - Last Name:SPICER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW, LICDC-CS
Mailing Address - Street 1:1545 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3158
Mailing Address - Country:US
Mailing Address - Phone:216-781-2250
Mailing Address - Fax:216-781-2295
Practice Address - Street 1:1545 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3158
Practice Address - Country:US
Practice Address - Phone:216-781-2250
Practice Address - Fax:216-781-2295
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991505101YA0400X
OHS00249801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)