Provider Demographics
NPI:1134938582
Name:BRAIN SPARK LEARNING CENTER
Entity type:Organization
Organization Name:BRAIN SPARK LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSTON-ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-994-3197
Mailing Address - Street 1:245 N. HIGHLAND AVE. NE
Mailing Address - Street 2:STE 230 #822
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307
Mailing Address - Country:US
Mailing Address - Phone:678-994-3197
Mailing Address - Fax:
Practice Address - Street 1:981 JOSEPH E LOWERY BLVD NW STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5286
Practice Address - Country:US
Practice Address - Phone:678-994-3197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty