# EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1861838492
- **Authorized official:** RICHARD EDWARDS (VP SERVICE LINE)
- **Authorized official phone:** (919) 783-8898

## Contact information

- **Practice address:** 10150 MALLARD CREEK RD, SUITE 510, CHARLOTTE, NC 28262-9708
- **Practice address phone:** (704) 333-8220
- **Mailing address:** 200 WEBB BLVD, PO BOX 629, HAVELOCK, NC 28532-1930
- **Mailing address phone:** (252) 447-3892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2013
- **Last updated:** 05/22/2013