Organization
SECOND CHANCE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KELLY ROBINSON EANES (EXECUTIVE DIRECTOR)
(434) 203-7538
Entity
Organization
Contact information
Practice address
22 E CHURCH ST STE 319, MARTINSVILLE, VA 24112-6208
(276) 403-5084
(276) 403-4207
Mailing address
22 E CHURCH ST STE 318, MARTINSVILLE, VA 24112-6208
(276) 403-5084
(276) 403-4207
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S5590577
STATE CORPORATION COMMISSION
VA
Enumeration date
02/04/2019
Last updated
02/04/2019
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