Provider Demographics
NPI:1750160537
Name:SPARKS, ISADORE DARRINTON II (MS)
Entity type:Individual
Prefix:
First Name:ISADORE
Middle Name:DARRINTON
Last Name:SPARKS
Suffix:II
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-2024
Mailing Address - Country:US
Mailing Address - Phone:773-984-9854
Mailing Address - Fax:
Practice Address - Street 1:2950 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-2024
Practice Address - Country:US
Practice Address - Phone:773-984-9854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health