Provider Demographics
NPI:1689921371
Name:SPELL, JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SPELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 DOUBLE CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL COVE
Mailing Address - State:MD
Mailing Address - Zip Code:21226-2219
Mailing Address - Country:US
Mailing Address - Phone:410-263-0222
Mailing Address - Fax:410-569-0094
Practice Address - Street 1:884 CHESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7049
Practice Address - Country:US
Practice Address - Phone:410-263-0222
Practice Address - Fax:410-569-0094
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional