Healthcare Provider Details

I. General information

NPI: 1477479533
Provider Name (Legal Business Name): A SECOND CHANCE PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE S
HENRICO VA
23294-4648
US

IV. Provider business mailing address

595 SOUTHLAKE BLVD
NORTH CHESTERFIELD VA
23236-8002
US

V. Phone/Fax

Practice location:
  • Phone: 804-822-0994
  • Fax:
Mailing address:
  • Phone: 804-822-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LATASHA C MATTHEWS
Title or Position: OWNER
Credential:
Phone: 804-822-0994