Provider Demographics
NPI:1528201811
Name:HOLMGREN, GINA SPARKS (MA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:SPARKS
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8783
Mailing Address - Country:US
Mailing Address - Phone:336-269-1013
Mailing Address - Fax:
Practice Address - Street 1:546 SANDY CROSS RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-7820
Practice Address - Country:US
Practice Address - Phone:336-951-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1921103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist