Organization
SPROUT AUTISM SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH FORTUNE BCBA, LBA (OWNER)
(757) 719-3472
Entity
Organization
Contact information
Practice address
242 MARTHA LEE DR, HAMPTON, VA 23666-3789
(757) 719-3472
Mailing address
242 MARTHA LEE DR, HAMPTON, VA 23666-3789
(757) 719-3472
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/12/2021
Last updated
08/12/2021
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