Provider Demographics
NPI:1073912796
Name:DEPINET-SPEARS, LORI J (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:DEPINET-SPEARS
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MEADOW DR STE C
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1389
Mailing Address - Country:US
Mailing Address - Phone:419-947-4055
Mailing Address - Fax:419-947-4285
Practice Address - Street 1:950 MEADOW DR STE C
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338
Practice Address - Country:US
Practice Address - Phone:419-947-4055
Practice Address - Fax:419-947-4285
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161737101YA0400X
OHI.18011321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)