Tina Long Spach, LCSW, LCAS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CO14780 Issued in NC

Practice address

791 Jonestown Rd
Winston Salem, NC 27103-1252

Phone

(336) 716-4551

Fax

(336) 716-9694

NPI assigned

Jul 8, 2019

Last updated

Dec 5, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellmood PLLC

  • Psychiatry Physician
  • Winston Salem, NC
  • NPI 1154182368
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1386206654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 KIMEL FOREST DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036074",
            "telephone_number": "336-713-0947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 JONESTOWN RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031252",
            "telephone_number": "336-716-4551",
            "fax_number": "336-716-9694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPACH",
        "first_name": "TINA",
        "middle_name": "LONG",
        "credential": "LCSW, LCAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-08",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-25654",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "CO14780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southside United Health Centers
• Southside United Health Centers
• Lilibeth Souvannarat
• Jessica Marie Souza, MD
• James Gregory Sowards, MD
• Kelly Ann Spaid, NP
• Allison Nicole Spain, COTA
• Kevin Leon Spainhour, N.P.
• Andrew Henican Spangler, MD
• Gina Shropshire Spangler, DDS, MS

• Clinical Social Worker in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.