# EASTER SEALS UCP NORTH CAROLINA & VIRGINIA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275969230
- **Authorized official:** RICHARD EDWARDS (VP)
- **Authorized official phone:** (919) 783-8898

## Contact information

- **Practice address:** 511 WILSON AVE, SPRING LAKE, NC 28390-3648
- **Practice address phone:** (919) 783-8898
- **Mailing address:** 5171 GLENWOOD AVE, SUITE 400, RALEIGH, NC 27612-3266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/23/2013
- **Last updated:** 01/15/2014