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General NPI Number Information
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NPI Number | 1720324536
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Entity Type | Organization
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Legal Business Name | EASTER SEALS UCP NORTH CAROLINA & VIRGINIA
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 3801 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-2934
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Country | US
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Telephone | 919-771-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-2934
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Country | US
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Telephone | 919-771-3128
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Fax |
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Authorized Official
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Title or Position | MST PROGRAM SUPERVISOR/OPT
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Name | MR. JAMES EDWARD ROBINSON
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Credential | LCSW-A
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Telephone | 919-771-3128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P006686
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License Number State | NC
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