Provider Demographics
NPI:1710047584
Name:SPARKS, JENNIFER NOLL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NOLL
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MCGARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:300 CAUGHMAN FARM LN APT 431
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6610
Mailing Address - Country:US
Mailing Address - Phone:908-342-7236
Mailing Address - Fax:
Practice Address - Street 1:300 CAUGHMAN FARM LN APT 431
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6610
Practice Address - Country:US
Practice Address - Phone:908-342-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058517001041C0700X
SC135161041C0700X
FL33461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical