Provider Demographics
NPI:1528096682
Name:SPENCER, DENISE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39393 VAN DYKE AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4635
Mailing Address - Country:US
Mailing Address - Phone:586-274-4394
Mailing Address - Fax:586-274-4701
Practice Address - Street 1:39393 VAN DYKE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4635
Practice Address - Country:US
Practice Address - Phone:586-274-4394
Practice Address - Fax:586-274-4701
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801032921103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral