Organization
SECOND CHANCE SUPPORT SERVICES LLC
Active
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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