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General NPI Number Information
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NPI Number | 1487345799
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE 2000 INC.
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 12840 HAMILTON AVE
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3588
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Country | US
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Telephone | 313-757-0721
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Fax |
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Provider Business Mailing Address
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Address Line | 16130 LITTLEFIELD ST
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City | DETROIT
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State | MI
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Zip | 48235-4224
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Country | US
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Telephone | 313-449-6644
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CARL WILLIAMS
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Credential |
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Telephone | 313-449-6644
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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