NPIMap

Organization Active NPI

Second Chance, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Martinsville, VA
National Provider Identifier
1194325191
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
SECOND CHANCE, LLC
Practice address
315 Hospital Dr Ste 105
Martinsville, VA 24112-1927
Phone
(276) 201-9506
NPI assigned
Oct 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa McIntoshNPI 1063064038
Title
LPC
Phone
(757) 320-9331

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

315 Hospital Dr Ste 105
Martinsville, VA 24112-1927

Mailing address

PO Box 3699
Martinsville, VA 24115-3699
Phone (757) 320-9331

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603843200000",
    "number": "1194325191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3699",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241153699",
            "telephone_number": "757-320-9331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 HOSPITAL DR STE 105",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241121927",
            "telephone_number": "276-201-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-28",
        "last_updated": "2020-10-28",
        "certification_date": "2020-10-28",
        "status": "A",
        "authorized_official_last_name": "MCINTOSH",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "LPC",
        "authorized_official_telephone_number": "757-320-9331"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.