# SPARK WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366131559
- **Authorized official:** STEPHANIE HIBBARD (PARTNER)
- **Authorized official phone:** (410) 245-2199

## Contact information

- **Practice address:** 692B RITCHIE HWY STE 101, SEVERNA PARK, MD 21146-3938
- **Practice address phone:** (410) 245-2199
- **Mailing address:** 102 STAUFFER RD, SEVERNA PARK, MD 21146-3021
- **Mailing address phone:** (410) 245-2199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2023
- **Last updated:** 05/03/2023