Provider Demographics
NPI:1619508850
Name:FISK SPARROW, AFTON ELIZABETH (LPCC, LPAT, ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:AFTON
Middle Name:ELIZABETH
Last Name:FISK SPARROW
Suffix:
Gender:F
Credentials:LPCC, LPAT, ATR-BC
Other - Prefix:
Other - First Name:AFTON
Other - Middle Name:ELIZABETH
Other - Last Name:FISK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LPAT, ATR-BC
Mailing Address - Street 1:6330 RIVERSIDE PLAZA LN NW STE 160
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2682
Mailing Address - Country:US
Mailing Address - Phone:505-633-8103
Mailing Address - Fax:
Practice Address - Street 1:6330 RIVERSIDE PLAZA LN NW STE 160
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2682
Practice Address - Country:US
Practice Address - Phone:505-444-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0201721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM98336843Medicaid