Healthcare Provider Details

I. General information

NPI: 1134938582
Provider Name (Legal Business Name): BRAIN SPARK LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 NEW HAMPSHIRE AVE STE 100
SILVER SPRING MD
20903-1422
US

IV. Provider business mailing address

245 N. HIGHLAND AVE. NE STE 230 #822
ATLANTA GA
30307
US

V. Phone/Fax

Practice location:
  • Phone: 678-994-3197
  • Fax:
Mailing address:
  • Phone: 678-994-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MISS ASHLEY HOUSTON-ISAAC
Title or Position: FOUNDER/CEO
Credential:
Phone: 678-994-3197