Organization
EASTER SEALS UCP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLY PERDUE (CLINICAL SUPERVISOR)
(704) 871-0934
Entity
Organization
Contact information
Practice address
913 CAROLINA AVE, STATESVILLE, NC 28677
(704) 871-0934
Mailing address
913 CAROLINA AVE, STATESVILLE, NC 28677
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
A10769
NC
Other
Enumeration date
05/14/2014
Last updated
05/14/2014
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