Organization
SECOND GENESIS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK SEGAL LCSW-C (DIRECTOR OF CLINICAL OPERATIONS)
(301) 563-1545
Entity
Organization
Contact information
Practice address
107 CIRCLE DR, CROWNSVILLE, MD 21032-2061
(301) 621-9013
Mailing address
8611 2ND AVE, SUITE 300, SILVER SPRING, MD 20910-3372
(301) 563-1545
(301) 563-1546
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
904039
MD
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
904039
MD
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
904039
MD
324500000X
Substance Abuse Rehabilitation Facility
Primary
1053589242
MD
Other
Enumeration date
01/03/2011
Last updated
01/03/2011
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