Individual
GENNA MARIE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6100 RADIO STATION ROAD, LA PLATA, MD 20646-2924
(301) 609-9887
(301) 609-9091
Mailing address
6100 RADIO STATION ROAD, LA PLATA, MD 20646-2924
(301) 609-9887
(301) 609-9091
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/24/2011
Last updated
02/24/2011
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