Healthcare Provider Details

I. General information

NPI: 1831756618
Provider Name (Legal Business Name): SECOND CHANCE HELP CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 RIBAULT SCENIC DR
JACKSONVILLE FL
32208-3111
US

IV. Provider business mailing address

1506 RIBAULT SCENIC DR
JACKSONVILLE FL
32208-3111
US

V. Phone/Fax

Practice location:
  • Phone: 904-616-3113
  • Fax:
Mailing address:
  • Phone: 904-616-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY WYCHE SR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 904-616-3113