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General NPI Number Information
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NPI Number | 1578378584
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Entity Type | Organization
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Legal Business Name | SPARK WELLNESS
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Dates
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Enumeration Date | 02/08/2025
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 2988 GEORGE WASHINGTON MEMORIAL HWY
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City | HAYES
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State | VA
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Zip | 23072-3429
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Country | US
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Telephone | 757-752-3839
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Fax |
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Provider Business Mailing Address
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Address Line | 2988 GEORGE WASHINGTON MEMORIAL HWY
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City | HAYES
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State | VA
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Zip | 23072-3429
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Country | US
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Telephone | 757-752-3839
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | ABIODUN BADAMOSI
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Credential |
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Telephone | 757-752-3839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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