Healthcare Provider Details

I. General information

NPI: 1992562508
Provider Name (Legal Business Name): SECOND CHANCE ADDICTION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E JEFFERSON ST STE 201
ROCKVILLE MD
20850-2617
US

IV. Provider business mailing address

401 E JEFFERSON ST STE 201
ROCKVILLE MD
20850-2617
US

V. Phone/Fax

Practice location:
  • Phone: 301-983-5130
  • Fax: 855-270-6701
Mailing address:
  • Phone: 301-983-5130
  • Fax: 855-270-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMBER VERMILLION
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 301-983-5130