Provider Demographics
NPI:1992421671
Name:2ND CHANCE COUNSELING
Entity type:Organization
Organization Name:2ND CHANCE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MED
Authorized Official - Phone:985-413-5137
Mailing Address - Street 1:316 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6157
Mailing Address - Country:US
Mailing Address - Phone:985-413-5137
Mailing Address - Fax:985-413-5137
Practice Address - Street 1:316 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-6157
Practice Address - Country:US
Practice Address - Phone:985-413-5137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty