Provider Demographics
NPI:1417197104
Name:SECOND CHANCE RECOVERY
Entity Type:Organization
Organization Name:SECOND CHANCE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALIFIED MENTAL HEALTH/SUBTANCE AB
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:BA, QMPH
Authorized Official - Phone:252-885-4548
Mailing Address - Street 1:4012 BENJAMIN COURT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1441
Mailing Address - Country:US
Mailing Address - Phone:252-885-4548
Mailing Address - Fax:
Practice Address - Street 1:4012 BENJAMIN CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-1441
Practice Address - Country:US
Practice Address - Phone:252-885-4548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health