Healthcare Provider Details

I. General information

NPI: 1689057812
Provider Name (Legal Business Name): MICHELE SPARKS MS/LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N MURRAY HILL RD
COLUMBUS OH
43228-1524
US

IV. Provider business mailing address

3974 BROWN PARK DR STE A
HILLIARD OH
43026-1168
US

V. Phone/Fax

Practice location:
  • Phone: 614-710-1496
  • Fax:
Mailing address:
  • Phone: 614-353-4157
  • Fax: 614-319-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE-0002792
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0002792
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: