MEDICARE: CATHERINE DANIELS SPARKMAN MS, LMHC, LPC

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	IMH 12226	FL
2	101YM0800X	Mental Health Counselor	14432	FL
3	101YP2500X	Professional Counselor	14666	NC

General Provider Information

NPI Number	:	1124424858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE DANIELS SPARKMAN MS, LMHC, LPC

Provider Business Mailing Address
First Line	:	1904 MIDDLE RIDGE DR
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-6821
Country	:	US
Telephone Number	:	850-459-0667
Fax Number	:

Provider Business Practice Location Address
First Line	:	1904 MIDDLE RIDGE DR
Second Line	:
City	:	WILLOW SPRING
State	:	NC
Zip	:	27592-6821
Country	:	US
Telephone Number	:	850-459-0667
Fax Number	:

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

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	03/11/2019

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