Provider Demographics
NPI:1447343280
Name:SPENCE, NIKIYA S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NIKIYA
Middle Name:S
Last Name:SPENCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2175 SORRENTO CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-9900
Mailing Address - Country:US
Mailing Address - Phone:707-638-7145
Mailing Address - Fax:404-287-2964
Practice Address - Street 1:1400 BUFORD HWY STE C1
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8722
Practice Address - Country:US
Practice Address - Phone:770-638-7145
Practice Address - Fax:404-287-2964
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0033821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ52129Medicare UPIN