Organization
STAUNTON MC 1 LLC
Active
Other names
Sprout Therapy, Elemy
Organization subpart
No
Provider details
NPI number
Authorized official
YURY YAKUBCHYK SR. MD (MEDICAL DIRECTOR)
(786) 210-8200
Entity
Organization
Contact information
Practice address
1775 TYSONS BLVD FL 5, MC LEAN, VA 22102-4285
(786) 210-8200
Mailing address
1775 TYSONS BLVD FL 5, MC LEAN, VA 22102-4285
(786) 210-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/27/2020
Last updated
09/27/2021
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