=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790548030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPARKS OF CHANGE COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2024
-----------------------------------------------------
Last Update Date | 03/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2951 WHITEFORD RD STE 201
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-7624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-256-4299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2951 WHITEFORD RD STE 201
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-7624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-256-4299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, THERAPIST
-----------------------------------------------------
Name | MEGAN SPARKS
-----------------------------------------------------
Credential | MS, LPC
-----------------------------------------------------
Telephone | 717-256-4299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------