Provider Demographics
NPI:1609046572
Name:SECOND CHANCE COUNSELING CENTER, INC.
Entity Type:Organization
Organization Name:SECOND CHANCE COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW LICDC
Authorized Official - Phone:614-635-9011
Mailing Address - Street 1:6011 COLUMBUS PIKE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8494
Mailing Address - Country:US
Mailing Address - Phone:614-635-9011
Mailing Address - Fax:614-635-9014
Practice Address - Street 1:6011 COLUMBUS PIKE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8494
Practice Address - Country:US
Practice Address - Phone:614-635-9011
Practice Address - Fax:614-635-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty