Provider Demographics
NPI:1851027650
Name:SPARKS, CATHERINE (LMSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 BITTERN
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-8697
Mailing Address - Country:US
Mailing Address - Phone:517-745-0454
Mailing Address - Fax:
Practice Address - Street 1:804 ROSEFIELD DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4455
Practice Address - Country:US
Practice Address - Phone:517-745-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010849701041C0700X
NCC0159811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical