Provider Demographics
NPI:1275614703
Name:SPARKS, ANNE NOLES (EDID LMHC)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:NOLES
Last Name:SPARKS
Suffix:
Gender:F
Credentials:EDID LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 TEGVESTA DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541
Mailing Address - Country:US
Mailing Address - Phone:850-654-9989
Mailing Address - Fax:850-654-9989
Practice Address - Street 1:303 TEGVESTA DR
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-654-9989
Practice Address - Fax:850-654-9989
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health