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Organization
PRODIGAL S D CORPORATION
Active
Organization
PRODIGAL S D CORPORATION
Active
Parent organization
PRODIGAL S D CORPORATION
Other names
Prodigal Kids
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRODIGAL S D CORPORATION
Authorized official
FREDA STEVENS (EXECUTIVE DIRECTOR)
(904) 930-4244
Entity
Organization
Contact information
Practice address
9521 SHELLIE RD STE 13, JACKSONVILLE, FL 32257-6174
(904) 930-4244
(954) 256-8140
Mailing address
9838 OLD BAYMEADOWS RD # 267, JACKSONVILLE, FL 32256-8101
(904) 930-4244
(954) 256-8140
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
NULL
101YP1600X
Pastoral Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
103TP2701X
Group Psychotherapy Psychologist
—
NULL
103TP2701X
Group Psychotherapy Psychologist
—
—
Other
Enumeration date
06/06/2017
Last updated
06/06/2017
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