Provider Demographics
NPI:1861876617
Name:SPENCER-ROSE, SHARON ELIZABETH (LPC, LAC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:SPENCER-ROSE
Suffix:
Gender:F
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4912
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71361-4912
Mailing Address - Country:US
Mailing Address - Phone:318-794-0531
Mailing Address - Fax:
Practice Address - Street 1:5801 JOYCE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-2510
Practice Address - Country:US
Practice Address - Phone:318-794-0531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1155101YA0400X
LA4737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)