Provider Demographics
NPI:1225531817
Name:SPARGER, TELETHIA
Entity Type:Individual
Prefix:
First Name:TELETHIA
Middle Name:
Last Name:SPARGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 BRINKLEY RD APT 101
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6156
Mailing Address - Country:US
Mailing Address - Phone:301-512-8623
Mailing Address - Fax:
Practice Address - Street 1:5010 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2320
Practice Address - Country:US
Practice Address - Phone:301-474-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health