Provider Demographics
NPI:1427325901
Name:SPARKS, KATHERINE LOUSIE (LMHC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LOUSIE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 POWERS ST
Mailing Address - Street 2:404
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3576
Mailing Address - Country:US
Mailing Address - Phone:347-613-1790
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE LEVY PL
Practice Address - Street 2:BOX 1268
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029
Practice Address - Country:US
Practice Address - Phone:212-987-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health