Basic Information
| Provider Information | |||||||||
| NPI: | 1235686890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPICER | ||||||||
| FirstName: | SARAH | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 155 | ||||||||
| Address2: | |||||||||
| City: | CHRISTOPHER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628220155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6187242401 | ||||||||
| FaxNumber: | 6187244628 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | CARMI | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628212223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6188424470 | ||||||||
| FaxNumber: | 6187244628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 149.018468 | IL | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | 149.018468 | IL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.