Provider Demographics
NPI:1477433407
Name:SECOND WIND LIFE SERVICES, LLC
Entity type:Organization
Organization Name:SECOND WIND LIFE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COSTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-695-9997
Mailing Address - Street 1:275 CHEYENNE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-8301
Mailing Address - Country:US
Mailing Address - Phone:843-695-9997
Mailing Address - Fax:854-300-4965
Practice Address - Street 1:1140 BOONE HILL RD STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-2402
Practice Address - Country:US
Practice Address - Phone:843-695-9997
Practice Address - Fax:854-300-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty