Individual
LIBBY SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC-I
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 671-0622
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
01-03-31
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
11/25/2014
Last updated
09/07/2022
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