Provider Demographics
NPI:1992585111
Name:2ND CHANCE PROMISE PROGRAM
Entity type:Organization
Organization Name:2ND CHANCE PROMISE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-563-8399
Mailing Address - Street 1:3113 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2939
Mailing Address - Country:US
Mailing Address - Phone:302-563-8399
Mailing Address - Fax:
Practice Address - Street 1:19 LAMBSON LN STE B102
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2118
Practice Address - Country:US
Practice Address - Phone:302-337-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty