Organization
EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NASHEBA KEY-ALLRED (CREDENTIALING SPECIALIST)
(919) 865-8632
Entity
Organization
Contact information
Practice address
913 N CAROLINA AVE, STATESVILLE, NC 28677-3414
(704) 402-1060
(704) 402-1065
Mailing address
5171 GLENWOOD AVE, SUITE 400, RALEIGH, NC 27612-3266
(919) 783-8898
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
—
8300675
—
NC
05
—
8300675A
—
NC
05
—
8300675B
—
NC
05
—
8300675F
—
NC
05
—
8300675G
—
NC
05
—
8300675H
—
NC
05
—
8300675I
—
NC
Enumeration date
12/15/2006
Last updated
08/17/2021
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