LIFES SECOND CHANCE TREATMENT CENTER LAKISHA HENDERSON NELSON SOLE MBR NPI 1821419201

NPI Information

LIFES SECOND CHANCE TREATMENT CENTER LAKISHA HENDERSON NELSON SOLE MBR is a methadone clinic center in Dallas, TX. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. LIFES SECOND CHANCE TREATMENT CENTER LAKISHA HENDERSON NELSON SOLE MBR NPI is 1821419201. The provider is registered as an organization entity type.

The provider's business location address is:

2615 S LANCASTER RD
DALLAS, TX
ZIP 75216-112
Phone: (214) 376-7388

The provider's authorized official is Lakisha Henderson .
The authorized official title is Owner and has the following contact phone number (469) 360-6794.

The CLIA number assigned to this NPI record is 45D2216989 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/2/2014 and was last updated on 5/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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