Individual
JAIME SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDPT
Contact information
Practice address
2708 WESTMOOR CT SW, OLYMPIA, WA 98502-5754
(360) 943-8810
Mailing address
271 E BALMORAL WAY, SHELTON, WA 98584-8598
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60742749
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO60742749
WASHINGTON STATE DEPT OF HEALTH
WA
Enumeration date
08/09/2018
Last updated
08/09/2018
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