Provider Demographics
NPI:1780329144
Name:SPARKS, SARA NICOLE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 SPIT BROOK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-5614
Mailing Address - Country:US
Mailing Address - Phone:603-821-0008
Mailing Address - Fax:603-554-8617
Practice Address - Street 1:61 SPIT BROOK RD STE 202
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5614
Practice Address - Country:US
Practice Address - Phone:603-821-0008
Practice Address - Fax:603-554-8617
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health