Provider Demographics
NPI:1245750355
Name:POWERS, JEANINE SPELT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:SPELT
Last Name:POWERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 POPLAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-2810
Mailing Address - Country:US
Mailing Address - Phone:865-919-0988
Mailing Address - Fax:
Practice Address - Street 1:407 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3407
Practice Address - Country:US
Practice Address - Phone:865-919-0988
Practice Address - Fax:276-525-4480
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002557103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical