Provider Demographics
NPI:1497120422
Name:SECOND CREATION INC.
Entity Type:Organization
Organization Name:SECOND CREATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-795-8447
Mailing Address - Street 1:1800 OLD PECOS TRL STE P
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4759
Mailing Address - Country:US
Mailing Address - Phone:505-795-8447
Mailing Address - Fax:505-213-0337
Practice Address - Street 1:1800 OLD PECOS TRL STE P
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4759
Practice Address - Country:US
Practice Address - Phone:505-795-8447
Practice Address - Fax:505-213-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0161941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22027718Medicaid