Provider Demographics
NPI:1982200770
Name:SPARKS, DAVID PATRICK (LMFT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PATRICK
Last Name:SPARKS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E LELAND RD STE C
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4954
Mailing Address - Country:US
Mailing Address - Phone:925-384-3997
Mailing Address - Fax:
Practice Address - Street 1:130 E LELAND RD STE C
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4954
Practice Address - Country:US
Practice Address - Phone:925-384-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT144824106H00000X
CAAMFT120510390200000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program