Second Wind Life Services, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SECOND WIND LIFE SERVICES, LLC

Practice address

1140 Boone Hill Rd Ste a
Summerville, SC 29483-2402

Phone

(843) 695-9997

Fax

(854) 300-4965

NPI assigned

Sep 2, 2025

Organization subpart

No

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

Authorized official

Name

Patricia L Costilla, LPCNPI 1184194250

Title

Owner/Counselor

Phone

(843) 695-9997

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patricia L Costilla, LPC

  • Mental Health Counselor
  • Summerville, SC
  • NPI 1184194250
  NPD Authorized official

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

{
    "created_epoch": "1756771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1477433407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 CHEYENNE RD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294838301",
            "telephone_number": "843-695-9997",
            "fax_number": "854-300-4965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 BOONE HILL RD STE A",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294832402",
            "telephone_number": "843-695-9997",
            "fax_number": "854-300-4965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND WIND LIFE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-02",
        "last_updated": "2025-09-02",
        "certification_date": "2025-09-02",
        "status": "A",
        "authorized_official_last_name": "COSTILLA",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/COUNSELOR",
        "authorized_official_telephone_number": "843-695-9997",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Summerville, SC
• Providers in Summerville, SC by specialty
• Mental Health Counselor in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.