Provider Demographics
NPI:1013563246
Name:SPARKS, SOLANA RAMONITA
Entity Type:Individual
Prefix:
First Name:SOLANA
Middle Name:RAMONITA
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 QUARRY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-5650
Mailing Address - Country:US
Mailing Address - Phone:919-696-7485
Mailing Address - Fax:
Practice Address - Street 1:309 W MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4385
Practice Address - Country:US
Practice Address - Phone:919-559-8690
Practice Address - Fax:919-882-1277
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional