| NPI | 1184153934 |
|---|---|
| Doing Business As | PRODIGAL KIDS |
| Entity Type | Organization |
| Authorized Contact | FREDA STEVENS Executive Director 904-930-4244 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 101YP2500X Counselor, Professional | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2017-06-06 |