Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 59588 | TX |
NPI | 1003166083 |
---|---|
Provider Name | Spencer Stultz |
First Address | Fort Stewart, GA 31314-5641 |
Second Address | Fort Stewart, GA 31314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 25/10/2019 |