Easter Seals Ucp North Carolina & Virgina, Inc.
Organization Active NPI Community/Behavioral Health Agency · Mount Airy, NC
NPI 1033271978 · NPPES record last updated Sep 20, 2021
Key facts
- NPI
- 1033271978
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- EASTER SEALS UCP NORTH CAROLINA & VIRGINA, INC.
- Practice address
- 414 W Lebanon St
Mount Airy, NC 27030-2954 - Phone
- (336) 789-9492
- Fax
- (336) 789-9587
- NPI assigned
- Dec 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Brett Beavers
- Title
- Credentialing Manager
- Phone
- (919) 210-7661
Corporate family (same tax ID) 18
Practitioners 9
-
Sara Sanderson Dodgens, LCAS, LCSW
-
Charlene Edwards, LCAS
-
Ashley Money Hamby, LCMHC
-
Linda Cheryl Jacobs, LPC
-
Tonya Carol Oakley, M.A.,L.M.F.T
-
Joshua Paul Simmons, LCSW-A
-
Shannon Leigh Culler, MSN, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101105000534 | NC | Part B Supplier - Clinic/Group Practice | 7618161407 |
Receives reassigned benefits from 79 practitioners This NPI is an additional NPI on the enrollment Practice locations: Raleigh, NC; Jacksonville, NC; New Bern, NC; Nags Head, NC; Mount Airy, NC; Morganton, NC; Morehead City, NC; Kinston, NC… |
National Provider Directory
- Tax ID family
- Easter Seals Ucp North Carolina Virginia Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | |||
| Case Management Agency | 251B00000X | |||
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
414 W Lebanon St
Mount Airy, NC 27030-2954
Mailing address
5171 Glenwood Ave
Suite 211
Raleigh, NC 27612-3266
Phone (919) 783-8898
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8300674A | Medicaid | NC | |
| 8300674I | Medicaid | NC | |
| 018KJ | Other | NC | NC BCBS |
| 8300674F | Medicaid | NC | |
| 8300674G | Medicaid | NC | |
| 8300674 | Medicaid | NC | |
| 8300674H | Medicaid | NC | |
| 8300674B | Medicaid | NC |
Other providers in Mount Airy, NC
- Lauren Dry
- Jeffery Bryant Eads
- William Webster Eads
- Lakin East
- Easter Seals Ucp NC & VA, Inc
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Marcy Easter
- Molly Kay Easter
- Sherrie Dawn Easter
All providers in Mount Airy, NC · Community/Behavioral Health Agency in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.