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General NPI Number Information
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NPI Number | 1689348468
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Entity Type | Organization
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Legal Business Name | PROSPERITY PATH, LLC
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 137 EBERT RD STE 7A
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City | MOORESVILLE
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State | NC
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Zip | 28117-7187
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Country | US
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Telephone | 704-615-3458
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Fax |
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Provider Business Mailing Address
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Address Line | 12430 CLACKWYCK LN
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City | CHARLOTTE
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State | NC
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Zip | 28262-1628
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Country | US
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Telephone | 704-615-3458
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JONATHAN CHRISTOPHER LILLEY
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Credential |
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Telephone | 704-615-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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