Individual
CRYSTAL SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICDC-CS, LSW
Contact information
Practice address
1012 WAVERLY AVE, TOLEDO, OH 43607-3736
(419) 822-6478
Mailing address
1012 WAVERLY AVE, TOLEDO, OH 43607-3736
(419) 531-6970
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
954159
OH
104100000X
Social Worker
S 0012385
OH
Other
Enumeration date
11/10/2014
Last updated
11/10/2014
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