Active NPI
Mallory Jo Spence, MSW, LCASA, LCSWA
- Clinical Social Worker
- Wilmington, NC
National Provider Identifier
1386253797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- P014258
- Practice address
- 3825 Market St Ste 4
Wilmington, NC 28403-1426 - Phone
- (910) 777-5575
- Fax
- (910) 777-5273
- NPI assigned
- Jul 31, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | LCAS-25514 | NC | |
| Clinical Social Worker | 1041C0700X | P014258 | NC | Primary |
Addresses
Primary practice location
3825 Market St Ste 4
Wilmington, NC 28403-1426
Mailing address
3825 Market St Ste 4
Wilmington, NC 28403-1426
Phone (910) 777-5575
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://www.wilmingtonmentalhealth.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 13, 2024 through Feb 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCAS-25514 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| P014258 | NC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649894400000",
"number": "1386253797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3825 MARKET ST STE 4",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284031426",
"telephone_number": "910-777-5575",
"fax_number": "910-777-5273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3825 MARKET ST STE 4",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284031426",
"telephone_number": "910-777-5575",
"fax_number": "910-777-5273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCE",
"first_name": "MALLORY",
"middle_name": "JO",
"credential": "MSW, LCASA, LCSWA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-31",
"last_updated": "2022-04-14",
"certification_date": "2022-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "LCAS-25514",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "P014258",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "https://www.wilmingtonmentalhealth.com",
"affiliation": "N",
"endpointDescription": "Website",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Website",
"address_1": "3825 Market St Ste 4",
"city": "Wilmington",
"state": "NC",
"country_code": "US",
"postal_code": "284031426",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.