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General NPI Number Information
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NPI Number | 1982742326
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Entity Type | Organization
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Legal Business Name | EASTER SEALS UCP NORTH CAROLINA
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 2315 MYRON DR
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City | RALEIGH
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State | NC
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Zip | 27607-3344
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Country | US
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Telephone | 704-566-6040
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Fax | 704-971-2537
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Provider Business Mailing Address
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Address Line | 5700 EXECUTIVE CENTER DR SUITE 110
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City | CHARLOTTE
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State | NC
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Zip | 28212-8858
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Country | US
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Telephone | 704-566-6040
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Fax | 704-971-2537
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Authorized Official
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Title or Position | CONTROLLER
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Name | MRS. SUSAN TWEED
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Credential |
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Telephone | 704-566-6040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 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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