Provider Demographics
NPI:1023845229
Name:SECOND CHANCES BEHAVIORAL ACHIEVEMENT SERVICES LLC
Entity type:Organization
Organization Name:SECOND CHANCES BEHAVIORAL ACHIEVEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GATLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-297-6962
Mailing Address - Street 1:71 TUSCARORA LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7335
Mailing Address - Country:US
Mailing Address - Phone:757-297-6962
Mailing Address - Fax:
Practice Address - Street 1:71 TUSCARORA LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-7335
Practice Address - Country:US
Practice Address - Phone:757-297-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty