# PRODIGAL S D CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PRODIGAL S D CORPORATION
- **Other names:** Prodigal Kids
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1184153934
- **Legal business name:** PRODIGAL S D CORPORATION
- **Authorized official:** FREDA STEVENS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (904) 930-4244

## Contact information

- **Practice address:** 9521 SHELLIE RD STE 13, JACKSONVILLE, FL 32257-6174
- **Practice address phone:** (904) 930-4244
- **Practice address fax:** (954) 256-8140
- **Mailing address:** 9838 OLD BAYMEADOWS RD \# 267, JACKSONVILLE, FL 32256-8101
- **Mailing address phone:** (904) 930-4244
- **Mailing address fax:** (954) 256-8140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 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