| NPI | 1679955181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA A SPARKS President/Owner 904-891-4565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY9173) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002794) |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2019-06-11 |