Provider Demographics
NPI:1467192997
Name:SPROUT BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:SPROUT BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:BALL
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPA, LBA, BCBA
Authorized Official - Phone:919-524-1175
Mailing Address - Street 1:9 WESTHAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-3787
Mailing Address - Country:US
Mailing Address - Phone:919-524-1175
Mailing Address - Fax:
Practice Address - Street 1:9 WESTHAMPTON CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3787
Practice Address - Country:US
Practice Address - Phone:919-524-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty