Healthcare Provider Details

I. General information

NPI: 1215325675
Provider Name (Legal Business Name): PROSPERITY RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 UNITED DR STE 100-B
DURHAM NC
27713-1661
US

IV. Provider business mailing address

631 UNITED DR STE 100-B
DURHAM NC
27713-1661
US

V. Phone/Fax

Practice location:
  • Phone: 919-636-0731
  • Fax:
Mailing address:
  • Phone: 919-636-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0000
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0000000
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000000
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0000000
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number0000000
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number0000000
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0000000
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0000000
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number00000000
License Number StateNC
# 10
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000000
License Number StateNC
# 11
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0000000
License Number StateNC
# 12
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number00000000
License Number StateNC

VIII. Authorized Official

Name: TONY TOSH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 919-636-0731