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Organization

INNER SPARK THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CORINA DAUGHERTY CALHOUN LCSW (OWNER, THERAPIST)
(971) 266-4355
Entity
Organization

Contact information

Practice address
134 S WASSON ST, COOS BAY, OR 97420-3235
(971) 266-4355
Mailing address
1995 NEWMARK AVE # 1012, COOS BAY, OR 97420-4727

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
08/21/2023
Last updated
08/21/2023
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