Individual
MELISSA R SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
104 LEGACY DR, BEREA, KY 40403-9594
(859) 986-2323
(859) 986-7728
Mailing address
1010 MAIN ST S, MC KEE, KY 40447-7089
(606) 287-7104
(606) 287-4409
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1592
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82000373
—
KY
Enumeration date
12/21/2005
Last updated
11/27/2019
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