Healthcare Provider Details

I. General information

NPI: 1114496676
Provider Name (Legal Business Name): MARGARITA SPARKS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6425 SCHAEFER RD STE 2
DEARBORN MI
48126-1974
US

IV. Provider business mailing address

6425 SCHAEFER RD STE 2
DEARBORN MI
48126-1974
US

V. Phone/Fax

Practice location:
  • Phone: 313-846-2606
  • Fax: 313-846-2657
Mailing address:
  • Phone: 313-846-2606
  • Fax: 313-846-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: