Provider Demographics
NPI:1427705177
Name:SPICER, JEREMIAH CHASE
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:CHASE
Last Name:SPICER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:SOPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:25921-1551
Mailing Address - Country:US
Mailing Address - Phone:304-222-3884
Mailing Address - Fax:
Practice Address - Street 1:175 PHILPOTT LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9501
Practice Address - Country:US
Practice Address - Phone:304-254-9262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)