Provider Demographics
NPI:1043759905
Name:DAWNEISHA SPRATLEY
Entity type:Organization
Organization Name:DAWNEISHA SPRATLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-331-6741
Mailing Address - Street 1:6726 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126
Mailing Address - Country:US
Mailing Address - Phone:267-331-6741
Mailing Address - Fax:
Practice Address - Street 1:6726 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126
Practice Address - Country:US
Practice Address - Phone:267-331-6741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007907251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health