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General NPI Number Information
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NPI Number | 1154039964
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Entity Type | Individual
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Provider Name | GINA M SPARACIO MS, LAC, LCADC, CCS,
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Gender | Female
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Dates
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Enumeration Date | 11/10/2022
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 5 CARROLL AVE STE 5
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City | PENNSVILLE
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State | NJ
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Zip | 08070-2129
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Country | US
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Telephone | 856-209-3799
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Fax |
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Provider Business Mailing Address
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Address Line | 12 HILLSIDE AVE
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City | BRIDGETON
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State | NJ
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Zip | 08302-3820
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Country | US
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Telephone | 609-847-4855
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00668600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00362100
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License Number State | NJ
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