Provider Demographics
NPI:1982980264
Name:SPENCER, JUANITA ELAINE (SUDCC II)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:ELAINE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:SUDCC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7600 GREENHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5604
Mailing Address - Country:US
Mailing Address - Phone:916-429-9030
Mailing Address - Fax:916-429-9029
Practice Address - Street 1:7240 E SOUTHGATE DR STE G
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2627
Practice Address - Country:US
Practice Address - Phone:916-391-4293
Practice Address - Fax:916-391-4247
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13911101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)