Organization
SOUL SPARK COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TESSA RENEE VANDERHORN LAC (INCORPORATOR/ORGANIZER)
(509) 306-1102
Entity
Organization
Contact information
Practice address
128 SOUTHWINDS RD, FARMINGTON, AR 72730-8678
(479) 222-1156
Mailing address
PO BOX 1121, PRAIRIE GROVE, AR 72753-1121
(479) 222-1156
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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