Provider Demographics
NPI:1518204999
Name:PRODIGY STUDENT SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:PRODIGY STUDENT SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FREEDOM SADIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:202-510-4192
Mailing Address - Street 1:2351 24TH ST SE
Mailing Address - Street 2:1827
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3426
Mailing Address - Country:US
Mailing Address - Phone:202-510-4192
Mailing Address - Fax:
Practice Address - Street 1:2351 24TH ST SE
Practice Address - Street 2:1827
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3426
Practice Address - Country:US
Practice Address - Phone:202-510-4192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14292251S00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency