Provider Demographics
NPI:1407156185
Name:FOUNDATIONS UNITED, PA
Entity Type:Organization
Organization Name:FOUNDATIONS UNITED, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA VERA
Authorized Official - Middle Name:C
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-900-7140
Mailing Address - Street 1:183 WIND CHIME CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6461
Mailing Address - Country:US
Mailing Address - Phone:919-900-7140
Mailing Address - Fax:919-848-3140
Practice Address - Street 1:183 WIND CHIME CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6461
Practice Address - Country:US
Practice Address - Phone:919-900-7140
Practice Address - Fax:919-848-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNORTH CAROLINAMedicaid