Provider Demographics
NPI:1154039964
Name:SPARACIO, GINA M (MS, LAC, CADC)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:SPARACIO
Suffix:
Gender:F
Credentials:MS, LAC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3820
Mailing Address - Country:US
Mailing Address - Phone:609-847-4855
Mailing Address - Fax:
Practice Address - Street 1:901 ROUTE 168 STE 104
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3200
Practice Address - Country:US
Practice Address - Phone:856-266-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00139400101YA0400X
NJ37AC00668600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)