Basic Information
| Provider Information | |||||||||
| NPI: | 1831798537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPIRAL GROWTH COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 3RD ST APT 5 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073580766 | ||||||||
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| Practice Location | |||||||||
| Address1: | 36 3RD ST APT 5 | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073580766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2020 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRASSLETT | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, MANAGER, CLINICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2073580766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCPC, LCMHC | ||||||||
| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 102L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychoanalyst | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.