1932594983 NPI number — SECOND CHANCE COUNSELING SERVICES, LLC

Table of content: (NPI 1932594983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932594983 NPI number — SECOND CHANCE COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SECOND CHANCE COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932594983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 882
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20871-0882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-972-1373
Provider Business Mailing Address Fax Number:
301-972-1584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13241 EXECUTIVE PARK TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20874-2648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-972-1373
Provider Business Practice Location Address Fax Number:
301-972-1584
Provider Enumeration Date:
04/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HAYES
Authorized Official First Name:
TERESE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-972-1373

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  12637 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com