Healthcare Provider Details

I. General information

NPI: 1518023076
Provider Name (Legal Business Name): SECOND CHANCE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 STAGE COACH LANE VILLAGE PARK
ORANGEBURG SC
29118-2499
US

IV. Provider business mailing address

108 STAGE COACH LANE VILLAGE PARK
ORANGEBURG SC
29118-2499
US

V. Phone/Fax

Practice location:
  • Phone: 803-516-0200
  • Fax: 803-516-8288
Mailing address:
  • Phone: 803-516-0200
  • Fax: 803-516-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4068
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES FURTICK JR.
Title or Position: DIRECTOR
Credential: PH.D
Phone: 803-516-0200