Provider Demographics
NPI:1831876853
Name:MILLARD, ANNA BROOKE SPARKS
Entity type:Individual
Prefix:
First Name:ANNA BROOKE
Middle Name:SPARKS
Last Name:MILLARD
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 1:1302 NOBLE ST STE 3F
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-4678
Mailing Address - Country:US
Mailing Address - Phone:256-225-6418
Mailing Address - Fax:
Practice Address - Street 1:3382 WOOLFOLK ROAD
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:AL
Practice Address - Zip Code:35160
Practice Address - Country:US
Practice Address - Phone:256-322-8632
Practice Address - Fax:256-798-2959
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health