| NPI | 1508531195 |
|---|---|
| Doing Business As | SPARK WELLNESS GROUP |
| Entity Type | Organization |
| Authorized Contact | LUIS EMILIO BETANCOURT Co Owner 704-770-7027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2021-08-16 |