| Sparkfit Community Inc | |
|
1202 Main St Ste 204 Little Rock AR 72202-5057 | |
| (501) 428-3217 | |
| Not Available |
| Full Name | Sparkfit Community Inc |
|---|---|
| Speciality | Counselor |
| Location | 1202 Main St Ste 204, Little Rock, Arkansas |
| Authorized Official Name and Position | Glenn Mccracken (OWNER) |
| Authorized Official Contact | 5014283217 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sparkfit Community Inc 1324b Main St Little Rock AR 72202-5034 Ph: (501) 400-8682 | Sparkfit Community Inc 1202 Main St Ste 204 Little Rock AR 72202-5057 Ph: (501) 428-3217 |
| NPI Number | 1417511387 |
|---|---|
| Provider Enumeration Date | 04/26/2019 |
| Last Update Date | 08/05/2024 |
| Certification Date | 08/05/2024 |
| Medicare PECOS PAC ID | 2961933205 |
|---|---|
| Medicare Enrollment ID | O20240927000795 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417511387 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| Provider Name | Jean Doss |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184782443 PECOS PAC ID: 6800885948 Enrollment ID: I20080923000846 |
| Provider Name | Jennifer Rose Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255548459 PECOS PAC ID: 2062744766 Enrollment ID: I20191030001250 |
| Provider Name | Heather Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205483211 PECOS PAC ID: 7416362173 Enrollment ID: I20210211000219 |
| Provider Name | Jessica Leigh Soule |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750947354 PECOS PAC ID: 9638575038 Enrollment ID: I20210910000583 |
| Provider Name | Vanessa Hardage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194400663 PECOS PAC ID: 2961855838 Enrollment ID: I20240126001635 |
| Provider Name | Elizabeth A Fowler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972175834 PECOS PAC ID: 7719422070 Enrollment ID: I20240710003811 |
| Provider Name | Glenn Mccracken |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114222932 PECOS PAC ID: 3870024110 Enrollment ID: I20240927000877 |
| Provider Name | Mary Catherine Yates Davison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356996540 PECOS PAC ID: 2567994767 Enrollment ID: I20241012000415 |
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