Provider Demographics
NPI:1053542514
Name:SPITZNOGLE, JAYNE DEON (LCSW)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:DEON
Last Name:SPITZNOGLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 J FRANK CULPEPPER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-5648
Mailing Address - Country:US
Mailing Address - Phone:229-630-2712
Mailing Address - Fax:
Practice Address - Street 1:2669 J FRANK CULPEPPER RD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-5648
Practice Address - Country:US
Practice Address - Phone:229-630-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-01
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical