Provider Demographics
NPI:1558311787
Name:SPARACINO, GRETCHEN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:SPARACINO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5032 CORAL REEF DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8166
Mailing Address - Country:US
Mailing Address - Phone:843-559-1220
Mailing Address - Fax:
Practice Address - Street 1:1982A MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2128
Practice Address - Country:US
Practice Address - Phone:843-475-6447
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health