Provider Demographics
NPI:1679259725
Name:RANSOM, SPARKLES (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:SPARKLES
Middle Name:
Last Name:RANSOM
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 LOWER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8206
Mailing Address - Country:US
Mailing Address - Phone:786-380-2235
Mailing Address - Fax:
Practice Address - Street 1:3141 LOWER CREEK DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8206
Practice Address - Country:US
Practice Address - Phone:786-380-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0065571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical