Provider Demographics
NPI:1164093506
Name:SQUIRES, JEANA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:MARIE
Last Name:SQUIRES
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 1:130 CARRIEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-6000
Mailing Address - Country:US
Mailing Address - Phone:540-486-4653
Mailing Address - Fax:540-486-4709
Practice Address - Street 1:520 S RALEIGH ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2642
Practice Address - Country:US
Practice Address - Phone:304-262-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09040130281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical