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General NPI Number Information
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NPI Number | 1336611912
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Entity Type | Organization
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Legal Business Name | PRODIGY COUNSELING SERVICES
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 17 WARREN RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-5334
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Country | US
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Telephone | 443-577-8959
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Fax |
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Provider Business Mailing Address
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Address Line | 8718 GILLY WAY
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5310
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Country | US
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Telephone | 443-577-8959
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MS. ASIA RAY
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Credential | LCPC
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Telephone | 443-577-8959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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