Organization
THERESA A. SPARKS, PH.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA A SPARKS PH.D. (PRESIDENT/OWNER)
(904) 891-4565
Entity
Organization
Contact information
Practice address
910 S 8TH ST STE 134, FERNANDINA BEACH, FL 32034-6700
(904) 891-4565
(904) 212-1216
Mailing address
910 S 8TH ST STE 134, FERNANDINA BEACH, FL 32034-6700
(904) 891-4565
(904) 212-1216
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY002794
GA
103TC0700X
Clinical Psychologist
Primary
PY9173
FL
Other
Enumeration date
06/20/2015
Last updated
06/11/2019
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