Provider Demographics
NPI:1376912949
Name:CORBAN GROUP INC
Entity type:Organization
Organization Name:CORBAN GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:704-560-8709
Mailing Address - Street 1:11503 SIR FRANCIS DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5803
Mailing Address - Country:US
Mailing Address - Phone:704-560-8706
Mailing Address - Fax:919-746-7490
Practice Address - Street 1:11503 SIR FRANCIS DRAKE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5803
Practice Address - Country:US
Practice Address - Phone:704-560-8706
Practice Address - Fax:919-746-7490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty