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General NPI Number Information
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NPI Number | 1619495876
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE BEHAVIORAL HEALTH CENTER LLC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 2502 MARYLAND AVE
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City | BALTIMORE
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State | MD
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Zip | 21218-4510
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Country | US
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Telephone | 443-660-6059
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Fax |
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Provider Business Mailing Address
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Address Line | 10045 ARDENNE WAY
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4072
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Country | US
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Telephone | 443-660-6059
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. TOWANDA RENEE TAYLOR
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Credential |
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Telephone | 443-660-6059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | MD
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