Organization
EASTER SEALS UCP NORTH CAROLINA & VIRGINA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT BEAVERS (CREDENTIALING MANAGER)
(919) 210-7661
Entity
Organization
Contact information
Practice address
414 W LEBANON ST, MOUNT AIRY, NC 27030-2954
(336) 789-9492
(336) 789-9587
Mailing address
5171 GLENWOOD AVE, SUITE 211, RALEIGH, NC 27612-3266
(919) 783-8898
(919) 782-5486
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018KJ
NC BCBS
NC
05
—
8300674
—
NC
05
—
8300674A
—
NC
05
—
8300674B
—
NC
05
—
8300674F
—
NC
05
—
8300674G
—
NC
05
—
8300674H
—
NC
05
—
8300674I
—
NC
Enumeration date
12/15/2006
Last updated
09/20/2021
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