# EASTER SEALS UCP NC & VA, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Easter Seals UCP NC & VA, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194887695
- **Authorized official:** NASHEBA KEY-ALLRED (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (919) 865-8632

## Contact information

- **Practice address:** 414 W LEBANON ST, MOUNT AIRY, NC 27030-2954
- **Practice address phone:** (336) 786-7079
- **Practice address fax:** (336) 786-6312
- **Mailing address:** 5171 GLENWOOD AVE, SUITE 400, RALEIGH, NC 27612-3266
- **Mailing address phone:** (919) 783-8898
- **Mailing address fax:** (919) 782-5486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 9901371 | NC | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 08/12/2019