Healthcare Provider Details

I. General information

NPI: 1457019820
Provider Name (Legal Business Name): 2ND CHANCE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 E EVANS ST STE E6A
FLORENCE SC
29506-2511
US

IV. Provider business mailing address

181 E EVANS ST STE E6A
FLORENCE SC
29506-2511
US

V. Phone/Fax

Practice location:
  • Phone: 843-874-0152
  • Fax: 843-799-2151
Mailing address:
  • Phone: 843-874-0152
  • Fax: 843-799-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: WENDY WASHINGTON
Title or Position: DIRECTOR/OWNER
Credential: LPC
Phone: 843-874-0152