Provider Demographics
NPI:1518023076
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:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FURTICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-516-0200
Mailing Address - Street 1:108 STAGE COACH LANE
Mailing Address - Street 2:VILLAGE PARK
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2499
Mailing Address - Country:US
Mailing Address - Phone:803-516-0200
Mailing Address - Fax:803-516-8288
Practice Address - Street 1:108 STAGE COACH LANE
Practice Address - Street 2:VILLAGE PARK
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2499
Practice Address - Country:US
Practice Address - Phone:803-516-0200
Practice Address - Fax:803-516-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
SC4068302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1049Medicaid