Organization
MD MC SPROUT 1 LLC
Active
Other names
Elemy, Sprout Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RAGHEB (COO)
(786) 210-8200
Entity
Organization
Contact information
Practice address
7761 DIAMONDBACK RD, COLLEGE PARK, MD 20740-3240
(301) 265-3520
Mailing address
7761 DIAMONDBACK RD, COLLEGE PARK, MD 20740-3240
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/18/2020
Last updated
09/27/2021
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