Provider Demographics
NPI:1952112567
Name:ANOTHER CHANCE PSYCHOTHERAPY AND CONSULTATION SERVICES, LLC
Entity type:Organization
Organization Name:ANOTHER CHANCE PSYCHOTHERAPY AND CONSULTATION SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARION
Authorized Official - Middle Name:AMMA
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-785-1500
Mailing Address - Street 1:301 S MCDOWELL ST
Mailing Address - Street 2:SUITE 125 #2179
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:980-785-1500
Mailing Address - Fax:
Practice Address - Street 1:5520 KELTONWOOD ROAD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278
Practice Address - Country:US
Practice Address - Phone:980-785-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty