Organization
2ND CHANCE MENTAL HEALTH CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHNNY BROWN (CEO/OWNER)
(772) 335-0166
Entity
Organization
Contact information
Practice address
1541 SE PORT ST LUCIE BLVD, SUITE F, PORT ST LUCIE, FL 34952-5456
(772) 335-0166
Mailing address
1541 SE PORT ST LUCIE BLVD, SUITE F, PORT ST LUCIE, FL 34952-5456
(772) 335-0166
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW9510
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003355500
—
FL
Enumeration date
09/21/2010
Last updated
05/06/2013
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