Provider Demographics
NPI:1184700965
Name:SPAHN, SANDRA J (MS)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:J
Last Name:SPAHN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 LEAF LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3747
Mailing Address - Country:US
Mailing Address - Phone:770-476-4550
Mailing Address - Fax:770-638-7356
Practice Address - Street 1:3068 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4914
Practice Address - Country:US
Practice Address - Phone:770-476-4550
Practice Address - Fax:770-638-7356
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC4069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional