Provider Demographics
NPI:1831077395
Name:SPARKS, ANIYAH (BS, RBT)
Entity type:Individual
Prefix:
First Name:ANIYAH
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10827
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-2827
Mailing Address - Country:US
Mailing Address - Phone:850-521-0242
Mailing Address - Fax:
Practice Address - Street 1:4820 KERRY FOREST PKWY STE A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-0201
Practice Address - Country:US
Practice Address - Phone:850-521-0242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT23317450106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician