# MD MC SPROUT 1 LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elemy, Sprout Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477165868
- **Authorized official:** MICHAEL RAGHEB (COO)
- **Authorized official phone:** (786) 210-8200

## Contact information

- **Practice address:** 7761 DIAMONDBACK RD, COLLEGE PARK, MD 20740-3240
- **Practice address phone:** (301) 265-3520
- **Mailing address:** 7761 DIAMONDBACK RD, COLLEGE PARK, MD 20740-3240

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |

## Other

- **Enumeration date:** 08/18/2020
- **Last updated:** 09/27/2021