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Organization
SECOND CHANCE HEALTHCARE
Active
Organization
SECOND CHANCE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAKITA LAVETT BEVERLY AGPCNP-C, PMHNP-BC (NURSE PRACTITIONER/OWNER)
(662) 374-3209
Entity
Organization
Contact information
Practice address
405 RIVER RD, GREENWOOD, MS 38930-4212
(662) 304-8805
(662) 362-8061
Mailing address
1101 MISSISSIPPI AVE, GREENWOOD, MS 38930-5224
(662) 374-3209
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
07/27/2024
Last updated
08/13/2024
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