Provider Demographics
NPI:1225894371
Name:SPARKS, MELISSA DAWN (BS QMHP CM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:SPARKS
Suffix:
Gender:F
Credentials:BS QMHP CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CROSSWINDS CENTER
Mailing Address - Street 2:414 INDUSTRIAL PARK ROAD
Mailing Address - City:MAXWELTON
Mailing Address - State:WV
Mailing Address - Zip Code:24957
Mailing Address - Country:US
Mailing Address - Phone:304-497-2850
Mailing Address - Fax:304-497-2805
Practice Address - Street 1:CROSSWINDS CENTER
Practice Address - Street 2:414 INDUSTRIAL PARK ROAD
Practice Address - City:MAXWELTON
Practice Address - State:WV
Practice Address - Zip Code:24957
Practice Address - Country:US
Practice Address - Phone:304-497-2850
Practice Address - Fax:304-497-2805
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator