Healthcare Provider Details

I. General information

NPI: 1447981477
Provider Name (Legal Business Name): SECOND CHANCE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 TYVOLA RD STE 112A
CHARLOTTE NC
28217-3535
US

IV. Provider business mailing address

756 TYVOLA RD STE 112A
CHARLOTTE NC
28217-3535
US

V. Phone/Fax

Practice location:
  • Phone: 646-270-2269
  • Fax: 888-980-9597
Mailing address:
  • Phone: 646-270-2269
  • Fax: 888-980-9597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ALBERTO LESLIE
Title or Position: OWNER
Credential:
Phone: 646-270-2269