Provider Demographics
NPI:1760544597
Name:SPARS, LISA CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:CAROL
Last Name:SPARS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1148 ARLINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-2322
Mailing Address - Country:US
Mailing Address - Phone:925-457-0966
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR BLDG 2 # MS 2-270
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-399-4948
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS182291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical