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NPI Code Detail

MEDICARE: SPARKLE RENEE LINDBLAD

MEDICARE: SPARKLE RENEE LINDBLAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorADT3834MD

General Provider Information

NPI Number : 1366305682
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPARKLE RENEE LINDBLAD
Provider Business Mailing Address
First Line : 780 W BEL AIR AVE STE B
Second Line :
City : ABERDEEN
State : MD
Zip : 21001-2236
Country : US
Telephone Number : 410-273-1030
Fax Number : 410-273-1040
Provider Business Practice Location Address
First Line : 780 W BEL AIR AVE STE B
Second Line :
City : ABERDEEN
State : MD
Zip : 21001-2236
Country : US
Telephone Number : 410-273-1030
Fax Number : 410-273-1040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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Directions to “ SPARKLE RENEE LINDBLAD ” Practice Location

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