Healthcare Provider Details

I. General information

NPI: 1225894371
Provider Name (Legal Business Name): MELISSA DAWN SPARKS B.S. QMHP CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CROSSWINDS CENTER 414 INDUSTRIAL PARK ROAD
MAXWELTON WV
24957
US

IV. Provider business mailing address

CROSSWINDS CENTER 414 INDUSTRIAL PARK ROAD
MAXWELTON WV
24957
US

V. Phone/Fax

Practice location:
  • Phone: 304-497-2850
  • Fax: 304-497-2805
Mailing address:
  • Phone: 304-497-2850
  • Fax: 304-497-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: