Provider Demographics
NPI:1164817268
Name:SECOND CHANCE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SECOND CHANCE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-972-1373
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-0882
Mailing Address - Country:US
Mailing Address - Phone:301-972-1373
Mailing Address - Fax:301-972-1584
Practice Address - Street 1:13241 EXECUTIVE PARK TER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2648
Practice Address - Country:US
Practice Address - Phone:301-972-1373
Practice Address - Fax:301-972-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4709101YP2500X
MDLC4819101YP2500X
MDLC5475101YP2500X
MDLC4015101YP2500X
MD126371041C0700X
MDDX3109133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty