| Organization Name: | PRODIGIOUS HEALTH SERVICES, LLC |
| NPI Number: | 1720389182 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BOBBY FAISON (PRESIDENT) |
| Mailing Address: | 210 N Main St Roxboro |
| State: | NC US |
| Postal Code: | 275735325 |
| Phone Number: | 2524330300 |
| Fax Number: | 2524338054 |
| NPI Enumeration Date: | 11/16/2010 |
| NPI Last Update Date: | 11/16/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 875 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |