Organization
SOUL SPARK COUNSELING & CONSULT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY DODSON LMFT (MANAGER)
(985) 774-4076
Entity
Organization
Contact information
Practice address
2112 BIENVILLE BLVD STE M1, OCEAN SPRINGS, MS 39564-3027
(601) 385-5638
(228) 366-9056
Mailing address
14205 S COUNTRY HILLS DR, GULFPORT, MS 39503-2518
(985) 774-4076
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
01/17/2023
Last updated
07/18/2024
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