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General NPI Number Information
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NPI Number | 1043708027
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Entity Type | Organization
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Legal Business Name | PRODIGY THERAPEUTIC SOLUTIONS LLC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 2727 PACES FERRY RD SE # 750
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City | ATLANTA
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State | GA
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Zip | 30339-4053
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Country | US
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Telephone | 470-965-6726
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 PACES FERRY RD SE # 727
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City | ATLANTA
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State | GA
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Zip | 30339-4053
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Country | US
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Telephone | 470-965-6726
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | LAPORSHE E SMITH
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Credential |
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Telephone | 404-399-4364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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