| Second Chance Support Services Llc | |
|
22 E Church St Ste 319 Martinsville VA 24112-6208 | |
| (276) 403-5084 | |
| (276) 403-4207 |
| Full Name | Second Chance Support Services Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 22 E Church St Ste 319, Martinsville, Virginia |
| Authorized Official Name and Position | Kelly Robinson Eanes (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4342037538 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Second Chance Support Services Llc 22 E Church St Ste 318 Martinsville VA 24112-6208 Ph: (276) 403-5084 | Second Chance Support Services Llc 22 E Church St Ste 319 Martinsville VA 24112-6208 Ph: (276) 403-5084 |
| NPI Number | 1245795269 |
|---|---|
| Provider Enumeration Date | 02/04/2019 |
| Last Update Date | 02/04/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245795269 | NPI | - | NPPES |
| S5590577 | Other | VA | STATE CORPORATION COMMISSION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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