Provider Demographics
NPI:1881494367
Name:MINDSPARKS
Entity type:Organization
Organization Name:MINDSPARKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-507-2692
Mailing Address - Street 1:8421 BROAD ST UNIT 2402
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3780
Mailing Address - Country:US
Mailing Address - Phone:703-507-2692
Mailing Address - Fax:
Practice Address - Street 1:8421 BROAD ST UNIT 2402
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3780
Practice Address - Country:US
Practice Address - Phone:703-507-2692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty