Provider Demographics
NPI:1992130165
Name:SPENCER, CHRISTOPHER DAVON
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:DAVON
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 1:240 N OAK ST APT D
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7727
Mailing Address - Country:US
Mailing Address - Phone:714-858-1491
Mailing Address - Fax:
Practice Address - Street 1:240 N OAK ST APT D
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7727
Practice Address - Country:US
Practice Address - Phone:714-858-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health