Provider Demographics
NPI:1679976823
Name:SPENCER, ALICIA (LLC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2539
Mailing Address - Country:US
Mailing Address - Phone:734-286-7107
Mailing Address - Fax:
Practice Address - Street 1:8333 TOWNSEND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-2331
Practice Address - Country:US
Practice Address - Phone:313-579-5824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health