Provider Demographics
NPI:1073375580
Name:SPEARS, MARIESHA DANIKA
Entity Type:Individual
Prefix:
First Name:MARIESHA
Middle Name:DANIKA
Last Name:SPEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BOOKOUT LOOP
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8618
Mailing Address - Country:US
Mailing Address - Phone:678-499-4603
Mailing Address - Fax:
Practice Address - Street 1:250 BOOKOUT LOOP
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8618
Practice Address - Country:US
Practice Address - Phone:678-499-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW010724104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker