Healthcare Provider Details

I. General information

NPI: 1609648211
Provider Name (Legal Business Name): JUST A SPARK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 SOUTHBRIDGE ST STE 100
AUBURN MA
01501-2541
US

IV. Provider business mailing address

500 SALISBURY ST
WORCESTER MA
01609-1265
US

V. Phone/Fax

Practice location:
  • Phone: 508-713-7930
  • Fax:
Mailing address:
  • Phone: 774-276-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY RAYMOND RICHARD
Title or Position: OWNER
Credential: LMHC
Phone: 508-713-7930