Spark Change Wellness Center, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SPARK CHANGE WELLNESS CENTER, LLC

Practice address

331 Gambrills Rd Ste 4B
Gambrills, MD 21054-1141

Phone

(410) 864-0201

NPI assigned

Sep 22, 2026

Last updated

Sep 22, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Renee Mack, PHD

Title

Psychologist

Phone

(302) 898-1720

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1992617963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 GAMBRILLS RD STE 4B",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 GAMBRILLS RD STE 4B",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541141",
            "telephone_number": "410-864-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARK CHANGE WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-22",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "RENEE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "302-898-1720",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arnold Jay Slutskin, DDS
• Crystal Marie Smith, CRNP
• La Toya Bianca Smith, PHD
• Min Song
• Southern Maryland Family Dental
• Dejanee Spraggins
• Kyle Randy Steiner, DC
• Raymond A Sterling Sr., PA-C
• Stewart and Labbe Orthodontics
• Strides Therapy LLC

• Mental Health Counselor in Gambrills, MD
• Providers in Gambrills, MD by specialty
• Mental Health Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.