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General NPI Number Information
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NPI Number | 1154274991
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Entity Type | Organization
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Legal Business Name | SPA PHILANTHROPY INC
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 30 FOX HOUND LN
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City | ANGIER
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State | NC
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Zip | 27501-7652
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Country | US
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Telephone | 919-346-6250
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Fax |
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Provider Business Mailing Address
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Address Line | 726 N MAIN ST UNIT 577
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-2029
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Country | US
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Telephone | 919-346-6250
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Fax |
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Authorized Official
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Title or Position | CEO/CLINICAL THERAPIST
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Name | ADEYOSOLA BASS
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Credential | LCSW
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Telephone | 919-292-5218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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