Organization
EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRETT BEAVERS (CREDENTIALING MANAGER)
(919) 210-7661
Entity
Organization
Contact information
Practice address
5000 FALLS OF NEUSE RD STE 300, RALEIGH, NC 27609-5480
(919) 865-8710
(919) 256-0772
Mailing address
5171 GLENWOOD AVE, SUITE 211, RALEIGH, NC 27612-3266
(919) 783-8898
(919) 782-5486
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300488
—
NC
05
—
8300672
—
NC
05
—
8300673
—
NC
05
—
8300675
—
NC
05
—
8300676
—
NC
05
—
8300709
—
NC
05
—
8300746
—
NC
05
—
8301327
—
NC
05
—
8301522
—
NC
05
—
8301523
—
NC
Enumeration date
06/21/2010
Last updated
10/17/2024
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