Provider Demographics
NPI:1891243291
Name:SPORS, NEVEAH JANET
Entity type:Individual
Prefix:
First Name:NEVEAH JANET
Middle Name:
Last Name:SPORS
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 1:95 THOMAS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4623
Mailing Address - Country:US
Mailing Address - Phone:207-907-0474
Mailing Address - Fax:
Practice Address - Street 1:61 MAIN ST STE 49
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6397
Practice Address - Country:US
Practice Address - Phone:207-907-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF5277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist