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General NPI Number Information
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NPI Number | 1942362884
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Entity Type | Organization
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Legal Business Name | EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 913 N CAROLINA AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-3414
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Country | US
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Telephone | 704-402-1060
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Fax | 704-402-1065
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Provider Business Mailing Address
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Address Line | 5171 GLENWOOD AVE SUITE 400
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City | RALEIGH
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State | NC
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Zip | 27612-3266
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Country | US
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Telephone | 919-783-8898
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | NASHEBA KEY-ALLRED
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Credential |
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Telephone | 919-865-8632
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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