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General NPI Number Information
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NPI Number | 1740068782
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Entity Type | Organization
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Legal Business Name | SPARKS HEALING GROUP
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Dates
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Enumeration Date | 09/20/2023
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 104 CHURCH LN STE 120
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City | PIKESVILLE
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State | MD
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Zip | 21208-3786
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Country | US
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Telephone | 410-709-8072
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Fax | 410-559-6510
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Provider Business Mailing Address
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Address Line | 104 CHURCH LN STE 120
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City | PIKESVILLE
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State | MD
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Zip | 21208-3786
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Country | US
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Telephone | 410-709-8072
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MR. BITALO ISAAC
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Credential |
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Telephone | 443-712-6672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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