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General NPI Number Information
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NPI Number | 1235776329
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Entity Type | Organization
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Legal Business Name | SPARKS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/08/2019
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Last Update Date | 12/08/2019
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Provider Practice Location Address
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Address Line | 101 MECHANIC ST
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City | GARDNER
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State | MA
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Zip | 01440-3119
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Country | US
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Telephone | 508-963-9526
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Fax |
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Provider Business Mailing Address
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Address Line | 12 FERN ST
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City | BALDWINVILLE
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State | MA
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Zip | 01436-1354
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Country | US
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Telephone | 508-963-9526
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACEY SPARKS
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Credential | CAGS, LMHC
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Telephone | 508-963-9526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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