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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