MEDICARE: CRYSTAL SPARKS LICDC-CS, LSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	954159	OH
2	104100000X	Social Worker	S 0012385	OH

General Provider Information

NPI Number	:	1821494469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL SPARKS LICDC-CS, LSW

Provider Business Mailing Address
First Line	:	1012 WAVERLY AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3736
Country	:	US
Telephone Number	:	419-531-6970
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 WAVERLY AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3736
Country	:	US
Telephone Number	:	419-822-6478
Fax Number	:

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

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

Similar Medicare Providers

1508463209 — LIBERTY GROUP FOUNDATION, LLC
Practice Location Address:

1002 WAVERLY AVE
TOLEDO, OH
43607-3736

Practice Phone: 419-917-9363
Practice Fax:

1285588640 — BLOSSOM WELLNESS SUPPORT
Practice Location Address:

321 AVALON PL
TOLEDO, OH
43611-3736

Practice Phone: 567-970-6288
Practice Fax:

1407680531 — TANEJA DIXON LPN
Practice Location Address:

321 AVALON PL
TOLEDO, OH
43611-3736

Practice Phone: 567-970-6288
Practice Fax:

1346188596 — STRIVE HEALTHCARE
Practice Location Address:

1203 UPTON AVE
TOLEDO, OH
43607-3733

Practice Phone: 567-440-8222
Practice Fax: 567-440-8222

1750237095 — RUSSELL TYRONE WATSON JR. QMHS
Practice Location Address:

2345 DORR ST
TOLEDO, OH
43607-3423

Practice Phone: 419-407-5342
Practice Fax: 419-407-5371

1194671438 — JAMES DARNELL FOSTER QMHS
Practice Location Address:

2345 DORR ST
TOLEDO, OH
43607-3423

Practice Phone: 419-407-5342
Practice Fax: 419-407-5371

Directions to “ CRYSTAL SPARKS LICDC-CS, LSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.