| Second Chance Counseling Services, Pllc | |
|
2935 Breezewood Ave Ste 103 Fayetteville NC 28303-5498 | |
| (910) 491-1758 | |
| Not Available |
| Full Name | Second Chance Counseling Services, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2935 Breezewood Ave Ste 103, Fayetteville, North Carolina |
| Authorized Official Name and Position | Sa'de J Robinson (CEO) |
| Authorized Official Contact | 9109887125 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Second Chance Counseling Services, Pllc 2935 Breezewood Ave Ste 103 Fayetteville NC 28303-5498 Ph: (910) 491-1758 | Second Chance Counseling Services, Pllc 2935 Breezewood Ave Ste 103 Fayetteville NC 28303-5498 Ph: (910) 491-1758 |
| NPI Number | 1801308143 |
|---|---|
| Provider Enumeration Date | 10/26/2017 |
| Last Update Date | 04/16/2020 |
| Certification Date | 04/16/2020 |
| Medicare PECOS PAC ID | 0345509527 |
|---|---|
| Medicare Enrollment ID | O20180116000624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801308143 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Sa'de J Robinson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376943738 PECOS PAC ID: 0840566535 Enrollment ID: I20171025000164 |
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