# SECOND CHANCE COUNSELING SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518023076
- **Authorized official:** DR. JAMES FURTICK JR. PH.D (DIRECTOR)
- **Authorized official phone:** (803) 516-0200

## Contact information

- **Practice address:** 108 STAGE COACH LANE, VILLAGE PARK, ORANGEBURG, SC 29118-2499
- **Practice address phone:** (803) 516-0200
- **Practice address fax:** (803) 516-8288
- **Mailing address:** 108 STAGE COACH LANE, VILLAGE PARK, ORANGEBURG, SC 29118-2499
- **Mailing address phone:** (803) 516-0200
- **Mailing address fax:** (803) 516-8288

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |
| 302F00000X | Exclusive Provider Organization | 4068 | SC | — |

## Other

- **Enumeration date:** 12/29/2006
- **Last updated:** 04/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | SW1049 | — | SC |