Individual
AMANDA LEAH SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW, NCC, LPCA
Contact information
Practice address
411 COURT ST, PORTSMOUTH, OH 45662
(740) 354-6685
Mailing address
411 COURT ST, PORTSMOUTH, OH 45662-3932
(740) 354-8004
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
166698
KY
101Y00000X
Counselor
C.1902344
OH
101YM0800X
Mental Health Counselor
Primary
E.20011683
OH
101YM0800X
Mental Health Counselor
QMHS
—
171M00000X
Case Manager/Care Coordinator
CMS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0375975
—
OH
Enumeration date
12/23/2014
Last updated
09/09/2020
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