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Organization

NEW OUTLOOK SECOND CHANCE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. BETHENA M JACKSON (EXECUTIVE DIRECTOR)
(919) 682-4771
Entity
Organization

Contact information

Practice address
331 W MAIN ST, SUITE 302-306, DURHAM, NC 27701-3232
(919) 682-4771
(919) 683-2641
Mailing address
331 W MAIN ST, SUITE 302-306, DURHAM, NC 27701-3232
(919) 682-4771
(919) 683-2641

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8302362B
NC
05
8302362G
NC
Enumeration date
04/09/2009
Last updated
04/09/2009
Update your record

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