# SEASIDE PSYCHOLOGICAL ASSESSMENTS AND RESOURCES FOR KIDS PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SPARKids
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902773682
- **Authorized official:** TIA CORNWALL ED.S., LPA (PARTNER)
- **Authorized official phone:** (540) 314-0606

## Contact information

- **Practice address:** 4902 MAIN ST STE D, SHALLOTTE, NC 28470-4749
- **Practice address phone:** (910) 754-2289
- **Mailing address:** PO BOX 1023, SHALLOTTE, NC 28459-1023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | Yes |
| 103T00000X | Psychologist | — | — | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 10/20/2025
- **Last updated:** 08/10/2026