Provider Demographics
NPI:1609594522
Name:SPREEISMS
Entity Type:Organization
Organization Name:SPREEISMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KYRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPREWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:678-457-4927
Mailing Address - Street 1:995 FLEETWOOD CIR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-2500
Mailing Address - Country:US
Mailing Address - Phone:678-457-4927
Mailing Address - Fax:
Practice Address - Street 1:995 FLEETWOOD CIR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-2500
Practice Address - Country:US
Practice Address - Phone:678-457-4927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty