Individual
MR. NICHOLAS ANDREW SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
91150COBURG INDUSTRIAL WAY, COBURG, OR 97408
(541) 687-1110
Mailing address
91150 COBURG INDUSTRIAL WAY, COBURG, OR 97408
(541) 687-1110
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-19-372
OR
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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