Organization
SEASIDE PSYCHOLOGICAL ASSESSMENTS AND RESOURCES FOR KIDS PLLC
Active
Other names
SPARKids
Organization subpart
No
Provider details
NPI number
Authorized official
TIA CORNWALL ED.S., LPA (PARTNER)
(540) 314-0606
Entity
Organization
Contact information
Practice address
4902 MAIN ST STE D, SHALLOTTE, NC 28470-4749
(910) 754-2289
Mailing address
PO BOX 1023, SHALLOTTE, NC 28459-1023
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
10/20/2025
Last updated
03/06/2026
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