Organization
EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD P EDWARDS (CONTRACT ADMINISTRATOR)
(919) 783-8898
Entity
Organization
Contact information
Practice address
4038 CAPITAL DR, ROCKY MOUNT, NC 27804-3123
(252) 467-2860
(252) 467-2865
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
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300676
—
NC
05
—
8300676A
—
NC
05
—
8300676B
—
NC
05
—
8300676G
—
NC
05
—
8300676H
—
NC
Enumeration date
12/19/2006
Last updated
11/20/2015
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