TINA LONG SPACH (NPI# 1386206654) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386206654 |
| Entity Type | Individual |
| Full Name | TINA LONG SPACH |
| Practice Address |
1615 Polo Rd Winston Salem NC 27106-3831 |
| Mailing Address |
713 S Marshall St Winston Salem NC 27101-5808 |
| Practice Telephone | 3367227266 |
| Practice Fax Number | 3362010538 |
| Mailing Telephone | 3367227266 |
| Mailing Fax Number | 3362010538 |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2019-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
P013799 | NC | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | LCAS-A LICENSE # 25654 | 25654 | 01 |
| NC | LCSW-A LICENSE # P013799 | P013799 | 01 |
| Street Address |
1615 POLO RD |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27106-3831 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427034768 | Christopher Bruns Aiken | Psychiatry & Neurology | 1615 Polo Rd, Winston Salem, NC 27106-3859 | 2005-12-19 |
| 1588159834 | Esther Simone Suess | Counselor | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2018-06-28 |
| 1336632009 | Bethany Godwin | Counselor | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2018-06-07 |
| 1740782507 | Rebecca Stevens | Counselor | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2018-03-07 |
| 1417495458 | Lindsay Reynolds | Social Worker | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2017-02-10 |
| 1649718180 | Kellie Newsome | Registered Nurse | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2017-02-04 |
| 1598213993 | Kelly Welch Joyce | Counselor | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2016-09-14 |
| 1053798694 | Valerie Vestal | Nurse Practitioner | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2015-05-04 |
| 1437568334 | Jill Elyse Gaukstern | Counselor | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2014-08-05 |
| 1053737148 | Anna Leisa Sauser | Counselor | 1615 Polo Rd, Winston Salem, NC 27106-3831 | 2014-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437799103 | Tyler Laura Lawrence | Behavioral Analyst | 1959 N Peace, 104, Winston-salem, NC 27106 | 2020-01-10 |
| 1316504624 | Amanda Baker | Behavior Technician | 1959 N Peace Haven Rd, Suite 104, Winston Salem, NC 27106 | 2019-05-22 |
| 1679030316 | Lavonda Williams | Behavior Technician | 1959 N Peace Haven Road, Winston Salem, NC 27106 | 2019-03-01 |
| 1518436708 | Angela Ruth Brown | Physical Therapy Assistant | 190 Moravian Way Drive, Winston-salem, NC 27106 | 2018-11-16 |
| 1407378896 | Applied Family Services of Winston-salem | Early Intervention Provider Agency | 4220 Witherow Rd, Winston Salem, NC 27106 | 2017-07-07 |
| 1750801676 | Julia Ann Horton | Speech-Language Pathologist | 2000 Salemtowne Drive, Winston Salem, NC 27106 | 2017-06-21 |
| 1124548037 | Tyler John Jones | Community Health Worker | 7014 Brandemere Ln. Apt F, Winston Salem, NC 27106 | 2017-06-21 |
| 1396274759 | Jennifer Cui | Social Worker | 3216 Cross Tree Rd, Winston-salem, NC 27106 | 2017-06-08 |
| 1063947802 | Rebecca Jeanette Mclemore | Social Worker | 4401 Providence Ln. #121, Top Priority Care Services, LLC., Winston-salem, NC 27106 | 2017-05-01 |
| 1720529357 | Rising Hope Clinical Assistance, LLC | Community/Behavioral Health | 510 Northgate Park Dr, Winston Salem, NC 27106 | 2017-03-15 |
| Find all providers in zip 27106 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649884362 | Ranesha Denae Boyd | Social Worker | 2270 Naomi Dr, Winston Salem, NC 27107-4602 | 2020-09-01 |
| 1326665563 | Kristy Dobbins | Social Worker | 3240 Trenchard Ln, Winston Salem, NC 27127-5927 | 2020-07-04 |
| 1033731781 | Robert D Worley | Social Worker | 480 Virginia Newell Ln, Winston Salem, NC 27101-4575 | 2020-05-15 |
| 1659900793 | Peaty Counseling and Consulting, Pllc | Social Worker | 1250 Foxhall Dr, Winston Salem, NC 27106-4436 | 2020-04-01 |
| 1407482862 | Jaime Wright | Social Worker | 3000 Bethesda Pl Ste 801, Winston Salem, NC 27103-3330 | 2020-03-18 |
| 1043778210 | Bernice Cook | Social Worker | 2223 Greenway Ave, Winston Salem, NC 27105-5120 | 2019-03-06 |
| 1285103812 | Kimberley Renee Hunt | Social Worker | 4711 Seminole Ct, Winston Salem, NC 27127-9432 | 2018-11-13 |
| 1619459864 | Shadae T Williams | Social Worker | 1224 Collegian Ter, Winston Salem, NC 27106-6340 | 2018-09-04 |
| 1104321017 | Melanie Carol Mccarthy | Social Worker | 1202 Miller St, Winston Salem, NC 27103-4445 | 2018-03-25 |
| 1417459371 | Awakenings Counseling | Social Worker | 770 Highland Oaks Dr # 100, Winston Salem, NC 27103-7105 | 2018-03-06 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27106 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.