Healthcare Provider Details

I. General information

NPI: 1114520053
Provider Name (Legal Business Name): YVETTE GINELL SPEARS CMT, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 W BRADDOCK RD STE 200
ALEXANDRIA VA
22302-1900
US

IV. Provider business mailing address

YVETTE SPEARS 6904 ROBINIA RD
CAMP SPRINGS MD
20748
US

V. Phone/Fax

Practice location:
  • Phone: 703-578-1900
  • Fax:
Mailing address:
  • Phone: 202-210-5277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019001314
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: