Organization
EASTER SEALS UCP NC & VA, INC
Active
Other names
Easter Seals UCP NC & VA, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
NASHEBA KEY-ALLRED (CREDENTIALING SPECIALIST)
(919) 865-8632
Entity
Organization
Contact information
Practice address
414 W LEBANON ST, MOUNT AIRY, NC 27030-2954
(336) 786-7079
(336) 786-6312
Mailing address
5171 GLENWOOD AVE, SUITE 400, RALEIGH, NC 27612-3266
(919) 783-8898
(919) 782-5486
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9901371
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018KJ
NC BCBS GROUP PROVIDER NU
NC
05
—
5903514
—
NC
Enumeration date
12/14/2006
Last updated
08/12/2019
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