| Prodigal Journey, Llc | |
|
33234 Kingslane Ct Apt 7 Farmington MI 48336-4054 | |
| (313) 702-3136 | |
| Not Available |
| Full Name | Prodigal Journey, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 33234 Kingslane Ct Apt 7, Farmington, Michigan |
| Authorized Official Name and Position | Todd Losie (CEO) |
| Authorized Official Contact | 2489561157 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prodigal Journey, Llc 33234 Kingslane Ct Apt 7 Farmington MI 48336-4054 Ph: (313) 702-3136 | Prodigal Journey, Llc 33234 Kingslane Ct Apt 7 Farmington MI 48336-4054 Ph: (313) 702-3136 |
| NPI Number | 1376257303 |
|---|---|
| Provider Enumeration Date | 01/13/2023 |
| Last Update Date | 01/15/2023 |
| Certification Date | 01/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376257303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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