Individual
BALTIMORE SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDC
Contact information
Practice address
571 SPENCER LN, SAN ANTONIO, TX 78201-2030
(210) 736-4405
Mailing address
571 SPENCER LN, SAN ANTONIO, TX 78201-2030
(210) 736-4405
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17012
TX
Other
Enumeration date
07/01/2024
Last updated
07/01/2024
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