Provider Demographics
NPI:1083014351
Name:SPENCE, DEJOISNET JEAN
Entity Type:Individual
Prefix:
First Name:DEJOISNET
Middle Name:JEAN
Last Name:SPENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEJOISNET
Other - Middle Name:
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2559 MANZANA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-4067
Mailing Address - Country:US
Mailing Address - Phone:619-306-6643
Mailing Address - Fax:
Practice Address - Street 1:2559 MANZANA WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-4067
Practice Address - Country:US
Practice Address - Phone:619-306-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)