Provider Demographics
NPI:1194376012
Name:STEPHANIE SPEARS, LCSW, PLLC
Entity Type:Organization
Organization Name:STEPHANIE SPEARS, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-835-3306
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-0428
Mailing Address - Country:US
Mailing Address - Phone:601-730-4401
Mailing Address - Fax:
Practice Address - Street 1:300 RAWLS DR STE 900
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2864
Practice Address - Country:US
Practice Address - Phone:601-730-4401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty