MEDICARE: JOURNEY TO PROSPERITY MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1184555682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY TO PROSPERITY MENTAL HEALTH

Provider Business Mailing Address
First Line	:	30 FRANKLIN ST STE AND208
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4504
Country	:	US
Telephone Number	:	804-946-5764
Fax Number	:	757-720-3584

Provider Business Practice Location Address
First Line	:	30 FRANKLIN ST STE AND208
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4504
Country	:	US
Telephone Number	:	804-946-5764
Fax Number	:	757-720-3584

Authorized Official
Title or Position	:	COOWNER
Name	:	SHANTA DENARD CLAY
Credential	:	LCSW
Telephone Number	:	224-425-9388

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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Directions to “JOURNEY TO PROSPERITY MENTAL HEALTH ” Practice Location

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