Healthcare Provider Details

I. General information

NPI: 1124345483
Provider Name (Legal Business Name): SECOND 2 NONE EDUCATIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9541 KINGS PARADE BLVD UNIT 117
CHARLOTTE NC
28273-5685
US

IV. Provider business mailing address

9541 KINGS PARADE BLVD. UNIT 117
CHARLOTTE NC
28273
US

V. Phone/Fax

Practice location:
  • Phone: 888-333-9003
  • Fax:
Mailing address:
  • Phone: 888-333-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TARNEISHA KENNTILLIA PETERS
Title or Position: PRESIDENT
Credential:
Phone: 407-963-2770