Organization
SPARK OF VIRGINIA, INC.
Active
Organization
SPARK OF VIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DWAYNE CHADWICK PARKER B.A., QMHP (EXECUTIVE DIRECTOR)
(804) 501-9614
Entity
Organization
Contact information
Practice address
7809 MIGRATION DR, RICHMOND, VA 23231-8937
(804) 501-9614
(804) 507-0644
Mailing address
PO BOX 7528, RICHMOND, VA 23231-0028
(804) 501-9614
(804) 507-0644
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
06858781
VA
Other
Enumeration date
02/28/2008
Last updated
02/28/2008
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