Organization
LIFES SECOND CHANCE TREATMENT CENTER LAKISHA HENDERSON NELSON SOLE MBR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKISHA HENDERSON (OWNER)
(469) 360-6794
Entity
Organization
Contact information
Practice address
2615 S LANCASTER RD, DALLAS, TX 75216-3112
(214) 376-7388
Mailing address
2615 S LANCASTER RD, DALLAS, TX 75216-3112
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
1000045
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000045
PERMIT
TX
Enumeration date
01/02/2014
Last updated
05/29/2020
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