Healthcare Provider Details

I. General information

NPI: 1427999663
Provider Name (Legal Business Name): SPARKLE PSYCHOLOGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 CARL VINSON PKWY STE 109
CENTERVILLE GA
31028-1419
US

IV. Provider business mailing address

951 CARL VINSON PKWY STE 109
CENTERVILLE GA
31028-1419
US

V. Phone/Fax

Practice location:
  • Phone: 478-888-6023
  • Fax:
Mailing address:
  • Phone: 478-888-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA CHARETTE
Title or Position: OWNER
Credential: PSYCHOLOGIST
Phone: 478-888-6023