Healthcare Provider Details

I. General information

NPI: 1578396529
Provider Name (Legal Business Name): SPARKLY LIFE HEALTH COACHING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 WESTRIDGE DR STE 1
HOCKESSIN DE
19707-2304
US

IV. Provider business mailing address

1521 CONCORD PIKE STE 301
WILMINGTON DE
19803-3644
US

V. Phone/Fax

Practice location:
  • Phone: 302-540-3870
  • Fax:
Mailing address:
  • Phone: 302-540-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PIALEE ROY
Title or Position: DIRECTOR
Credential:
Phone: 302-540-3870