Provider Demographics
NPI:1578378584
Name:SPARK WELLNESS
Entity type:Organization
Organization Name:SPARK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIODUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BADAMOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-752-3839
Mailing Address - Street 1:2988 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAYES
Mailing Address - State:VA
Mailing Address - Zip Code:23072-3429
Mailing Address - Country:US
Mailing Address - Phone:757-752-3839
Mailing Address - Fax:
Practice Address - Street 1:2988 GEORGE WASHINGTON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3429
Practice Address - Country:US
Practice Address - Phone:757-752-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty