Healthcare Provider Details

I. General information

NPI: 1881494367
Provider Name (Legal Business Name): MINDSPARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 WESTWOOD CENTER DR STE 303
VIENNA VA
22182-2231
US

IV. Provider business mailing address

8605 WESTWOOD CENTER DR STE 303
VIENNA VA
22182-2231
US

V. Phone/Fax

Practice location:
  • Phone: 703-507-2692
  • Fax: 703-712-7436
Mailing address:
  • Phone: 703-507-2692
  • Fax: 703-712-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: OMAIRA QAZI
Title or Position: OWNER
Credential:
Phone: 703-507-2692