Healthcare Provider Details

I. General information

NPI: 1881528602
Provider Name (Legal Business Name): SPARKLE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 S BIG BEND BLVD
SAINT LOUIS MO
63117-2208
US

IV. Provider business mailing address

8933 COZENS AVE
JENNINGS MO
63136-3980
US

V. Phone/Fax

Practice location:
  • Phone: 314-529-1391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: