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General NPI Number Information
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NPI Number | 1992585111
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Entity Type | Organization
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Legal Business Name | 2ND CHANCE PROMISE PROGRAM
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 19 LAMBSON LN STE B102
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City | NEW CASTLE
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State | DE
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Zip | 19720-2118
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Country | US
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Telephone | 302-337-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 3113 N VAN BUREN ST
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City | WILMINGTON
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State | DE
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Zip | 19802-2939
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Country | US
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Telephone | 302-563-8399
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. ANDRE V HALEY
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Credential | PH.D.
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Telephone | 302-563-8399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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