Provider Demographics
NPI:1679722904
Name:SPEARS, STEPHANIE DION (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DION
Last Name:SPEARS
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 1:1037 BILL BACOT RD
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-8459
Mailing Address - Country:US
Mailing Address - Phone:601-551-1868
Mailing Address - Fax:
Practice Address - Street 1:300 RAWLS DR STE 900
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2864
Practice Address - Country:US
Practice Address - Phone:601-730-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC46491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05187326Medicaid