# SHERRY V. SPARKS, LCSW, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sherry V. Sparks, LCSW
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528080561
- **Authorized official:** SHERRY V. SPARKS M.S.W., L.C.S.W. (LICENSED CLINICAL SOCIAL WORKER)
- **Authorized official phone:** (601) 383-8089

## Contact information

- **Practice address:** 840 E RIVER PL, SUITE 504, JACKSON, MS 39202-3493
- **Practice address phone:** (601) 383-8089
- **Practice address fax:** (601) 969-7160
- **Mailing address:** 840 E RIVER PL, SUITE 504, JACKSON, MS 39202-3493
- **Mailing address phone:** (601) 383-8089
- **Mailing address fax:** (601) 969-7160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | C7419 | MS | Yes |

## Other

- **Enumeration date:** 07/25/2006
- **Last updated:** 08/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 302G809006 | MEDICARE GROUP PTAN | MS |