Provider Demographics
NPI:1114001088
Name:2ND II NONE FOUNDATION
Entity Type:Organization
Organization Name:2ND II NONE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, LPC, NCC
Authorized Official - Phone:704-566-6134
Mailing Address - Street 1:PO BOX 480794
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-5323
Mailing Address - Country:US
Mailing Address - Phone:704-566-6134
Mailing Address - Fax:704-566-6136
Practice Address - Street 1:5820 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3541
Practice Address - Country:US
Practice Address - Phone:704-566-6134
Practice Address - Fax:704-566-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6005700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005700Medicaid