SPARK COUNSELING CENTER, LLC (NPI# 1942767140) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942767140 |
| Entity Type | Organization |
| Organization Name | SPARK COUNSELING CENTER, LLC |
| Practice Address |
3427 Washington Ave Gulfport MS 39507-3039 |
| Mailing Address |
Po Box 2937 Gulfport MS 39505-2937 |
| Practice Telephone | 5043009811 |
| Practice Fax Number | 8004163070 |
| Mailing Telephone | 5043009811 |
| Mailing Fax Number | 8004163070 |
| Enumeration Date | 2019-02-23 |
| Last Update Date | 2019-02-23 |
| Authorized Official Name | MARY DODSON (REGISTERED AGENT/OWNER) |
| Authorized Official Telephone | 5043009811 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
3427 WASHINGTON AVE |
| City | GULFPORT |
| State | MS |
| Zip Code | 39507-3039 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851808893 | Cori L Walker | Counselor | 3427 Washington Ave, Gulfport, MS 39507-3039 | 2017-12-29 |
| 1720566201 | Resilience Psychotherapy, Pllc | Counselor | 3427 Washington Ave, Gulfport, MS 39507-3039 | 2018-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609389105 | Karen R Burns | Speech-Language Pathologist | 3506 Washington Avenue, Ste E, Gulfport, MS 39507 | 2017-11-07 |
| 1538605027 | Andrea Broussard | Personal Emergency Response Attendant | 406 Pass Rd, Gulfport, MS 39507 | 2017-01-09 |
| 1366872491 | William Alexis Marcia | Pharmacist | 1444 East Pass Road, Gulfport, MS 39507 | 2013-11-27 |
| 1740599380 | Advanced Hearing Systems, Inc. | Hearing Instrument Specialist | 401 Security Square, Gulfport, MS 39507 | 2010-09-30 |
| 1497068118 | Stacey Ritter Carter | Dentist | 1635 East Pass Road, Gulfport, MS 39507 | 2010-07-22 |
| 1477789964 | Letonoff Orthopaedics & Sports | Orthopaedic Surgery | 452 Court House Road, Suite G, Gulfport, MS 39507 | 2009-06-10 |
| 1730385139 | Bernard Frederick Podlin | Dentist | 400 Pass Road, Gulfport, MS 39507 | 2007-06-22 |
| 1043422553 | Mark D Stringer | Dentist | 520-a Courthouse Road, Gulfport, MS 39507 | 2007-05-04 |
| 1154543528 | Pass Road Elementary | Registered Nurse | 37 Pass Road, Gulfport, MS 39507 | 2007-05-03 |
| 1417073768 | John Hough Hopkins | Dentist | 3303 A Ave, Gulfport, MS 39507 | 2007-03-21 |
| Find all providers in zip 39507 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619582418 | Monica Jean Davis | Counselor | 1601 49th St S, Gulfport, FL 33707-4340 | 2020-09-09 |
| 1396380234 | Jasmine L. Smith | Counselor | 1520 29th Ave Ste 3, Gulfport, MS 39501-2843 | 2019-11-14 |
| 1437710605 | Bridgette Denise Harris | Counselor | 12450 Three Rivers Rd # A-13, Gulfport, MS 39503-2970 | 2019-06-27 |
| 1174010292 | Charla Ann Wilson | Counselor | 2352 E Pass Rd, Gulfport, MS 39507-3805 | 2018-04-13 |
| 1851808893 | Cori L Walker | Counselor | 3427 Washington Ave, Gulfport, MS 39507-3039 | 2017-12-29 |
| 1467964270 | Melissa Lee Georgopolis | Counselor | 5800 20th Ave S, Gulfport, FL 33707-4050 | 2017-11-02 |
| 1376928697 | Holly Arnoult | Counselor | 240b Courthouse Rd, Gulfport, MS 39507-1214 | 2015-07-28 |
| 1942696596 | Debra Steinfeld | Counselor | 1608 53rd St S, Gulfport, FL 33707-4237 | 2015-04-10 |
| 1538500350 | Jaime Kathryn Parker | Counselor | 370 Courthouse Rd Ste 102, Gulfport, MS 39507-1889 | 2013-07-09 |
| 1215279047 | Estelle Lacoste Robinson | Counselor | 1455 E Pass Rd, B, Gulfport, MS 39507-3523 | 2013-03-19 |
| Find all providers in GULFPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.