Provider Demographics
NPI:1851836597
Name:SECOND CHANCE OR MORE COUNSELING SERVICES
Entity Type:Organization
Organization Name:SECOND CHANCE OR MORE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC,LMHC,MFT
Authorized Official - Phone:407-462-5483
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-1018
Mailing Address - Country:US
Mailing Address - Phone:407-462-5483
Mailing Address - Fax:
Practice Address - Street 1:110 EVANS MILL DR
Practice Address - Street 2:SUITE 401
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-1622
Practice Address - Country:US
Practice Address - Phone:407-462-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007084251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00313130Medicaid