Individual
NICOLE ANTOINETTE WARE SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY D
Contact information
Practice address
4325 1ST AVE # 1461, TUCKER, GA 30084-4498
(678) 404-1077
Mailing address
PO BOX 1461, TUCKER, GA 30085-1461
(470) 810-7811
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301013431
MI
103T00000X
Psychologist
Primary
PSY004171
GA
Other
Enumeration date
06/13/2007
Last updated
01/12/2023
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