Healthcare Provider Details

I. General information

NPI: 1962335711
Provider Name (Legal Business Name): SECOND CHANCE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 CHURCH ST N STE B
CONCORD NC
28025-4548
US

IV. Provider business mailing address

420 CHURCH ST N STE B
CONCORD NC
28025-4548
US

V. Phone/Fax

Practice location:
  • Phone: 704-649-6297
  • Fax:
Mailing address:
  • Phone: 704-649-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MOLIQUE SPENCER
Title or Position: C EO
Credential:
Phone: 704-649-6297