Provider Demographics
NPI:1164171716
Name:BRAVE SPARROW COUNSELING, LLC
Entity Type:Organization
Organization Name:BRAVE SPARROW COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-228-3863
Mailing Address - Street 1:6 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3761
Mailing Address - Country:US
Mailing Address - Phone:603-545-5088
Mailing Address - Fax:
Practice Address - Street 1:6 S STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3761
Practice Address - Country:US
Practice Address - Phone:603-228-3862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty