Individual
JASON SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
9677 MAIN ST, FAIRFAX, VA 22031-3763
(301) 767-1733
Mailing address
9677 MAIN ST, FAIRFAX, VA 22031-3763
(301) 767-1733
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0704014992
VA
Other
Enumeration date
06/30/2022
Last updated
05/07/2024
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