Provider Demographics
NPI:1699466516
Name:SPENCER, SALADIN K
Entity type:Individual
Prefix:
First Name:SALADIN
Middle Name:K
Last Name:SPENCER
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 1:180 GRAFTON LN
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22611-2576
Mailing Address - Country:US
Mailing Address - Phone:540-955-2400
Mailing Address - Fax:
Practice Address - Street 1:3103 SHAWNEE DR APT 7
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4276
Practice Address - Country:US
Practice Address - Phone:646-234-0492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical