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:
Health care specialties
Specialty | Code | License # | 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 6 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1538138367 | NPPES |
Georgia | MEDICAID | 699989780A |
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