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General NPI Number Information
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NPI Number | 1053008870
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Entity Type | Organization
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Legal Business Name | 2ND CHANCE BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 10620 N 43RD AVE STE 10
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City | GLENDALE
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State | AZ
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Zip | 85304-4150
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Country | US
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Telephone | 602-860-0044
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Fax | 602-848-3186
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Provider Business Mailing Address
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Address Line | 10620 N 43RD AVE STE 10
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City | GLENDALE
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State | AZ
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Zip | 85304-4150
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Country | US
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Telephone | 602-860-0044
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Fax | 602-848-3186
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DOMITY AKOI
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Credential | CEO
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Telephone | 602-860-0044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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