Organization
GA SPROUT MC 1 LLC
Active
Other names
Elemy, Sprout Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
YURY YAKUBCHYK SR. (OWNER)
(404) 738-7658
Entity
Organization
Contact information
Practice address
3455 PEACHTREE RD NE FL 5, ATLANTA, GA 30326-3254
(833) 991-2368
(929) 384-7193
Mailing address
3455 PEACHTREE RD NE FL 5, ATLANTA, GA 30326-3254
(833) 991-2368
(929) 384-7193
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/08/2020
Last updated
09/27/2021
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