Provider Demographics
NPI:1508598996
Name:SPARKS, RACHEL (LLMSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38713 GAINSBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3249
Mailing Address - Country:US
Mailing Address - Phone:586-854-9942
Mailing Address - Fax:
Practice Address - Street 1:44777 HAYES RD STE C
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1421
Practice Address - Country:US
Practice Address - Phone:586-242-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511064931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical