Provider Demographics
NPI:1114520053
Name:SPEARS, YVETTE GINELL (CMT, CLC)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:GINELL
Last Name:SPEARS
Suffix:
Gender:F
Credentials:CMT, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YVETTE SPEARS
Mailing Address - Street 2:6904 ROBINIA RD
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20748
Mailing Address - Country:US
Mailing Address - Phone:202-210-5277
Mailing Address - Fax:
Practice Address - Street 1:3543 W BRADDOCK RD STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1900
Practice Address - Country:US
Practice Address - Phone:703-578-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X, 247000000X
VA0019001314225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0019001314OtherVA BOARD OF NURSING
DC009583436IOtherINT'L COACH FEDERATION - WELLNESS COACH
MD79243OtherAMERICAN MASSAGE THERAPIST ASSOCIATION