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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
1103TC2200XClinical Child & Adolescent Psychologist

Other Identifiers

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

General Provider Information

NPI Number : 1861838492
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC
Provider Business Mailing Address
First Line : 200 WEBB BLVD
Second Line : PO BOX 629
City : HAVELOCK
State : NC
Zip : 28532-1930
Country : US
Telephone Number : 252-447-3892
Fax Number :
Provider Business Practice Location Address
First Line : 10150 MALLARD CREEK RD
Second Line : SUITE 510
City : CHARLOTTE
State : NC
Zip : 28262-9708
Country : US
Telephone Number : 704-333-8220
Fax Number :
Authorized Official
Title or Position : VP SERVICE LINE
Name : RICHARD EDWARDS
Credential :
Telephone Number : 919-783-8898
Provider Enumeration Date : 05/22/2013
Last Update Date : 05/22/2013

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