Healthcare Provider Details

I. General information

NPI: 1164548954
Provider Name (Legal Business Name): 2ND II NONE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 E WT HARRIS BLVD SUITE 111
CHARLOTTE NC
28215-3541
US

IV. Provider business mailing address

PO BOX 480794
CHARLOTTE NC
28269-5323
US

V. Phone/Fax

Practice location:
  • Phone: 704-566-6134
  • Fax: 704-566-6136
Mailing address:
  • Phone: 704-566-6134
  • Fax: 704-566-6136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS SCOTT CORBETT
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: MA, LMHC, LPC, NCC
Phone: 704-566-6134