Healthcare Provider Details

I. General information

NPI: 1134610322
Provider Name (Legal Business Name): SECOND CHANCE BEHAVIORAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 MARYLAND AVE
BALTIMORE MD
21218-4510
US

IV. Provider business mailing address

10045 ARDENNE WAY
OWINGS MILLS MD
21117-4072
US

V. Phone/Fax

Practice location:
  • Phone: 410-504-9048
  • Fax:
Mailing address:
  • Phone: 410-504-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TOWANDA TAYLOR
Title or Position: CEO
Credential:
Phone: 410-504-9048