Second Chance Youth Community Center Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

07088392 Issued in GA

Legal business name

SECOND CHANCE YOUTH COMMUNITY CENTER INC

Practice address

3303 Salem Rd
Covington, GA 30016-1865

Phone

(978) 219-3577

Fax

(770) 267-3248

NPI assigned

Sep 20, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mirline Lozispolynice, PHD

Title

Ceo

Phone

(678) 468-9295

Specialties & licenses 1

Addresses

Other names 1

• Second Chance Social Services Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379635200000",
    "number": "1023444197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2899 H D ATHA RD",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300140728",
            "telephone_number": "678-468-9295",
            "fax_number": "770-267-3248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 SALEM RD",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300161865",
            "telephone_number": "978-219-3577",
            "fax_number": "770-267-3248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE YOUTH COMMUNITY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-20",
        "last_updated": "2013-09-20",
        "status": "A",
        "authorized_official_last_name": "LOZISPOLYNICE",
        "authorized_official_first_name": "MIRLINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-468-9295",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "07088392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Second Chance Social Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Natally Scroggins, PMHNP
• Pamela Viola Seales-Mathieson
• Shoanmarie Seals, D.C.
• Vanessa Joy Sears, M.T.
• Jonathon Chrystopher Colman Seawright, MD
• Martine Seraphin, CCMA
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• Maureen Shaffield, ICADC, CTS, SAM
• Karuna Shah, DO

• Community/Behavioral Health Agency in Covington, GA
• Providers in Covington, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.