Healthcare Provider Details

I. General information

NPI: 1073475000
Provider Name (Legal Business Name): INNER FIRE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 DISTRICT WAY
DICKINSON ND
58601-5135
US

IV. Provider business mailing address

PO BOX 244
DICKINSON ND
58602-0244
US

V. Phone/Fax

Practice location:
  • Phone: 701-504-5804
  • Fax:
Mailing address:
  • Phone: 701-504-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHANNING SPRADLING
Title or Position: OWNER
Credential: LCSW
Phone: 701-504-5804