Organization
SPARK COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY DODSON LMFT (REGISTERED AGENT/OWNER)
(504) 300-9811
Entity
Organization
Contact information
Practice address
3427 WASHINGTON AVE, GULFPORT, MS 39507-3039
(504) 300-9811
(800) 416-3070
Mailing address
PO BOX 2937, GULFPORT, MS 39505-2937
(504) 300-9811
(800) 416-3070
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
02/23/2019
Last updated
02/23/2019
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