Provider Demographics
NPI:1821795980
Name:SPARKS, WENDY (LLMFT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-2517
Mailing Address - Country:US
Mailing Address - Phone:210-204-7149
Mailing Address - Fax:
Practice Address - Street 1:5900 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2378
Practice Address - Country:US
Practice Address - Phone:947-888-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist