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Organization
SPARKS
Active
Organization
SPARKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA WARD (COO)
(252) 320-2859
Entity
Organization
Contact information
Practice address
677 GRASMERE ST, WINTERVILLE, NC 28590-9669
(252) 320-2859
Mailing address
677 GRASMERE ST, WINTERVILLE, NC 28590-9669
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/19/2011
Last updated
10/19/2011
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