Sparks, Theresa A

Sparks, Theresa A is an individual health care provider with primary practice located at 910 S 8Th St Ste 134 , Fernandina Beach FL 32034-6700. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Sparks, Theresa A can be contacted via phone (904) 891-4565.

Contact Information

Primary practice address
910 S 8Th St Ste 134 Fernandina Beach FL 32034-6700
Phone: (904) 891-4565
Fax: (904) 212-1216
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PSY002794 Georgia
Behavioral Health & Social Service Providers / Clinical 103TC0700X PY9173 Florida

Profile Details

NPI number 1538138367
LBN Legal business name Sparks, Theresa A
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 15th, 2006
Last updated Jun 11th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538138367 NPPES
Georgia MEDICAID 699989780A

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