Healthcare Provider Details

I. General information

NPI: 1174431001
Provider Name (Legal Business Name): SECOND LIFE BEHAVIORAL HEALTH & RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 FENWAY ST
SAVANNAH GA
31407-1216
US

IV. Provider business mailing address

109 FENWAY ST
SAVANNAH GA
31407-1216
US

V. Phone/Fax

Practice location:
  • Phone: 413-320-1124
  • Fax:
Mailing address:
  • Phone: 413-320-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RONALD WILLIAMS
Title or Position: OWNER/CEO
Credential: LICSW, LADC1
Phone: 413-320-1124