Healthcare Provider Details

I. General information

NPI: 1336064930
Provider Name (Legal Business Name): AZZANNI SPARROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 PRINCESS ANNE RD
VIRGINIA BEACH VA
23462-3222
US

IV. Provider business mailing address

6309 TOWNSEND PL
SUFFOLK VA
23435-3070
US

V. Phone/Fax

Practice location:
  • Phone: 757-489-1215
  • Fax:
Mailing address:
  • Phone: 757-489-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019379
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709025388
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: