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NPI Code Detail

MEDICARE: 2ND II NONE FOUNDATION

MEDICARE: 2ND II NONE FOUNDATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency

General Provider Information

NPI Number : 1336265032
Entity Type Code : Organization
Provider Name (Legal Business Name) : 2ND II NONE FOUNDATION
Provider Business Mailing Address
First Line : PO BOX 480794
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-5323
Country : US
Telephone Number : 704-566-6134
Fax Number : 704-566-6136
Provider Business Practice Location Address
First Line : 5820 E WT HARRIS BLVD
Second Line : SUITE 111
City : CHARLOTTE
State : NC
Zip : 28215-3541
Country : US
Telephone Number : 704-566-6134
Fax Number : 704-566-6136
Authorized Official
Title or Position : DIRECTOR OF CLINICAL SERVICES
Name : MR. THOMAS SCOTT CORBETT
Credential : MA, LMHC, LPC, NCC
Telephone Number : 704-566-6134
Provider Enumeration Date : 03/22/2007
Last Update Date : 08/22/2020

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Directions to “2ND II NONE FOUNDATION ” Practice Location

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