| 2nd Ii None Foundation | |
|
5820 E Wt Harris Blvd Suite 111 Charlotte NC 28215-3541 | |
| (704) 566-6134 | |
| (704) 566-6136 |
| Full Name | 2nd Ii None Foundation |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5820 E Wt Harris Blvd, Charlotte, North Carolina |
| Authorized Official Name and Position | Thomas Scott Corbett (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7045666134 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 2nd Ii None Foundation Po Box 480794 Charlotte NC 28269-5323 Ph: (704) 566-6134 | 2nd Ii None Foundation 5820 E Wt Harris Blvd Suite 111 Charlotte NC 28215-3541 Ph: (704) 566-6134 |
| NPI Number | 1114001088 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114001088 | NPI | - | NPPES |
| 6005700 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 6005700 (North Carolina) | Primary |
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