Provider Demographics
NPI:1245530500
Name:SECOND CHANCES COMPREHENSIVE SERVICES
Entity type:Organization
Organization Name:SECOND CHANCES COMPREHENSIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMION
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-733-1180
Mailing Address - Street 1:1919 COMMERCE DR
Mailing Address - Street 2:SUITE 420
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4269
Mailing Address - Country:US
Mailing Address - Phone:757-262-2002
Mailing Address - Fax:757-262-2003
Practice Address - Street 1:1919 COMMERCE DR
Practice Address - Street 2:SUITE 420
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4269
Practice Address - Country:US
Practice Address - Phone:757-262-2002
Practice Address - Fax:757-262-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1389251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health