Provider Demographics
NPI:1013457977
Name:SPEARS, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SPEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 RIVERVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-1641
Mailing Address - Country:US
Mailing Address - Phone:678-634-9237
Mailing Address - Fax:
Practice Address - Street 1:1026 OLD PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2530
Practice Address - Country:US
Practice Address - Phone:678-634-9237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-26
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral