Provider Demographics
NPI:1124345483
Name:SECOND 2 NONE EDUCATIONAL SERVICES
Entity type:Organization
Organization Name:SECOND 2 NONE EDUCATIONAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARNEISHA
Authorized Official - Middle Name:KENNTILLIA
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-963-2770
Mailing Address - Street 1:9541 KINGS PARADE BLVD.
Mailing Address - Street 2:UNIT 117
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273
Mailing Address - Country:US
Mailing Address - Phone:888-333-9003
Mailing Address - Fax:
Practice Address - Street 1:9541 KINGS PARADE BLVD
Practice Address - Street 2:UNIT 117
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5685
Practice Address - Country:US
Practice Address - Phone:888-333-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency