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NPI Code Detail

MEDICARE: EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.

MEDICARE: EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2018 KJOTHERNCNC BCBS GROUP

General Provider Information

NPI Number : 1265594105
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Provider Business Mailing Address
First Line : 5171 GLENWOOD AVE
Second Line : SUITE 400
City : RALEIGH
State : NC
Zip : 27612-3266
Country : US
Telephone Number : 919-783-8898
Fax Number : 919-782-5486
Provider Business Practice Location Address
First Line : 433 W MAIN ST
Second Line :
City : DURHAM
State : NC
Zip : 27701-3217
Country : US
Telephone Number : 919-433-0170
Fax Number : 919-433-0156
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. RICHARD P EDWARDS
Credential :
Telephone Number : 919-783-8898
Provider Enumeration Date : 12/15/2006
Last Update Date : 11/23/2010

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