Provider Demographics
NPI:1275846388
Name:ANOTHER CHANCEE, INC.
Entity Type:Organization
Organization Name:ANOTHER CHANCEE, INC.
Other - Org Name:ANOTHER CHANCEE CASE MANAGEMENT AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, MDIV
Authorized Official - Phone:214-377-8495
Mailing Address - Street 1:114 EMPIRE CENTRAL DRIVE SUITE 260
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:214-203-0803
Practice Address - Street 1:1140 EMPIRE CENTRAL DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-432-8296
Practice Address - Fax:214-203-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-17
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
TX12479251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311513101Medicaid