Provider Demographics
NPI:1265063408
Name:SPRAGUE, MEAGHAN ROSE (LMHC)
Entity type:Individual
Prefix:MS
First Name:MEAGHAN
Middle Name:ROSE
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ALMY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-7520
Mailing Address - Country:US
Mailing Address - Phone:401-871-0110
Mailing Address - Fax:
Practice Address - Street 1:1246 CHALKSTONE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3904
Practice Address - Country:US
Practice Address - Phone:401-521-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC01126101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health