Healthcare Provider Details

I. General information

NPI: 1790040822
Provider Name (Legal Business Name): SECOND CHANCE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2012
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 HOSPITAL DR
THOMSON GA
30824-2121
US

IV. Provider business mailing address

PO BOX 10
THOMSON GA
30824-0010
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-2548
  • Fax: 706-595-3070
Mailing address:
  • Phone: 706-595-2548
  • Fax: 706-595-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006021
License Number StateGA

VIII. Authorized Official

Name: MR. CHARLES EDWARD JONES
Title or Position: CEO
Credential: LPC
Phone: 706-595-2548