Provider Demographics
NPI:1427487537
Name:DOVERSPIKE, TANIA (MHC)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:DOVERSPIKE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 THURBER DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1649
Mailing Address - Country:US
Mailing Address - Phone:315-539-1985
Mailing Address - Fax:315-539-4393
Practice Address - Street 1:3 THURBER DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-9454
Practice Address - Country:US
Practice Address - Phone:315-539-1985
Practice Address - Fax:315-539-4393
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health