MEDICARE: KAYLEA NICOLE SPARROW LCMHCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	A18491	NC

General Provider Information

NPI Number	:	1578257929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEA NICOLE SPARROW LCMHCA

Provider Business Mailing Address
First Line	:	4220 SECTION VIEW LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-9702
Country	:	US
Telephone Number	:	980-215-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	11351 NORTHWOODS FOREST DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-8816
Country	:	US
Telephone Number	:	980-288-4501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	04/07/2026

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