Provider Demographics
NPI:1598076168
Name:SPENCE, JEANETTE EHLERS (APRN, PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:EHLERS
Last Name:SPENCE
Suffix:
Gender:F
Credentials:APRN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ATRIUM WAY STE 221
Mailing Address - Street 2:LAKE PSYCHOLOGICAL SERVICES
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6383
Mailing Address - Country:US
Mailing Address - Phone:803-699-8887
Mailing Address - Fax:803-699-8824
Practice Address - Street 1:115 ATRIUM WAY STE 221
Practice Address - Street 2:LAKE PSYCHOLOGICAL SERVICES
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6383
Practice Address - Country:US
Practice Address - Phone:803-699-8887
Practice Address - Fax:803-699-8824
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4184364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult