Provider Demographics
NPI:1083821391
Name:SPEAR, JEANINE D (LMFT & LPC)
Entity type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:D
Last Name:SPEAR
Suffix:
Gender:F
Credentials:LMFT & LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9407
Mailing Address - Country:US
Mailing Address - Phone:336-362-5626
Mailing Address - Fax:
Practice Address - Street 1:1316 TRINITY AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-8358
Practice Address - Country:US
Practice Address - Phone:336-362-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4885101YP2500X
NC989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional