Organization
A PRODIGAL'S PATH 2 RECOVERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES LOYD STALLINGS LADAC II, MAC (PROGRAM MANAGER)
(865) 730-6628
Entity
Organization
Contact information
Practice address
107 PAINT ROCK FERRY RD, KINGSTON, TN 37763-2921
(865) 730-6628
(865) 730-6792
Mailing address
107 PAINT ROCK FERRY RD, KINGSTON, TN 37763-2921
(865) 730-6628
(865) 730-6792
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
05/22/2020
Last updated
05/22/2020
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