Provider Demographics
NPI:1902925803
Name:SPOONER, SHIRLEY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:SPOONER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 BOARDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHERRYLOG
Mailing Address - State:GA
Mailing Address - Zip Code:30522-2321
Mailing Address - Country:US
Mailing Address - Phone:706-698-4144
Mailing Address - Fax:706-492-3400
Practice Address - Street 1:942 BLUE RIDGE DR
Practice Address - Street 2:
Practice Address - City:MC CAYSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30555-2504
Practice Address - Country:US
Practice Address - Phone:706-492-2020
Practice Address - Fax:706-492-3400
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1065101YM0800X
GALPC003342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional