Individual
MS. KIMBERLY ELIZABETH SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
12201 PACIFIC AVE S, TACOMA, WA 98444-5126
(253) 536-6425
Mailing address
12201 PACIFIC AVE S, TACOMA, WA 98444-5126
(253) 536-6425
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60097366
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP60097366
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
01/03/2014
Last updated
04/09/2015
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