Southeast Second Chance, Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW003287 Issued in GA

Legal business name

SOUTHEAST SECOND CHANCE, INC

Practice address

600 G St Ste 6
Brunswick, GA 31520-6727

Phone

(912) 265-2055

Fax

(912) 265-2509

NPI assigned

Mar 19, 2007

Last updated

Feb 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Stephanie Cruwys, LCSWNPI 1841302247

Title

Owner

Phone

(912) 265-2055

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephanie Cruwys, LCSW

  • Clinical Social Worker
  • Brunswick, GA
  • NPI 1841302247
  Medicare reassignment NPD Authorized official
• Candace Shepherd

  • Clinical Social Worker
  • Brunswick, GA
  • NPI 1770901951
  NPD (past)

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675641600000",
    "number": "1932223302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2727",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315212727",
            "telephone_number": "912-265-2055",
            "fax_number": "912-265-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 G ST STE 6",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315206727",
            "telephone_number": "912-265-2055",
            "fax_number": "912-265-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST SECOND CHANCE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A",
        "authorized_official_last_name": "CRUWYS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-265-2055",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "851663137A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Georgia Hematology/Oncology Assoc.
• Southeast Georgia Open MRI LLC
• Southeast Georgia Urology Associates PC
• Southeast Lung & Critical Care Specialists
• Southeast Lung & Critical Care Specialists, PC (Southeast Lung Associates)
• Southeast Support Services
• Southeastern OB-GYN, P.C.
• Southeastern Pathology Associate
• Southeastern Pathology Associates PC
• Southeastern Pathology Associates PC

• Clinical Social Worker in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.