Provider Demographics
NPI:1487047411
Name:SCARBOROUGH-SPARKS, MARY (LISW/S)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:SCARBOROUGH-SPARKS
Suffix:
Gender:F
Credentials:LISW/S
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:LOU
Other - Last Name:SCARBOROUGH-SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW/S
Mailing Address - Street 1:7162 READING RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3838
Mailing Address - Country:US
Mailing Address - Phone:513-761-6222
Mailing Address - Fax:
Practice Address - Street 1:7162 READING RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3838
Practice Address - Country:US
Practice Address - Phone:513-761-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHIOOOO2748101Y00000X
OHI0002748101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional