Individual
TINA REBECCA SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
333 RIO RANCHO BLVD NE STE 200, RIO RANCHO, NM 87124-1458
(505) 814-1460
Mailing address
206 SANTA ELENA RD SE, RIO RANCHO, NM 87124-1307
(314) 276-8728
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CTB-2023-0074
NM
Other
Enumeration date
04/06/2023
Last updated
04/06/2023
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