Provider Demographics
NPI:1700380334
Name:SPEARS, DOUGLAS (CDCA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SPEARS
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-1334
Mailing Address - Country:US
Mailing Address - Phone:740-592-6724
Mailing Address - Fax:740-592-6728
Practice Address - Street 1:120 TWIN OAKS DR UNIT D
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9506
Practice Address - Country:US
Practice Address - Phone:740-577-3450
Practice Address - Fax:740-577-3451
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163693101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2864002Medicaid