Provider Demographics
NPI:1922209949
Name:SPARE, MICHAEL A (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SPARE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MAIN ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1744
Mailing Address - Country:US
Mailing Address - Phone:606-487-8484
Mailing Address - Fax:606-487-9372
Practice Address - Street 1:470 MAIN ST
Practice Address - Street 2:STE. 2
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1744
Practice Address - Country:US
Practice Address - Phone:606-487-8484
Practice Address - Fax:606-487-9372
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical