Active NPI
Easter Seals Ucp North Carolina & Virginia, Inc.
- Mental Health Counselor
- Raleigh, NC
National Provider Identifier
1124185657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Legal business name
- EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
- Practice address
- 4000 Wake Forest Rd
Ste 200
Raleigh, NC 27609-6879 - Phone
- (919) 861-1600
- Fax
- (919) 861-1637
- NPI assigned
- Jan 3, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Richard P Edwards
- Title
- Contract Administrator
- Phone
- (919) 783-8898
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary | ||
| Community/Behavioral Health Agency | 251S00000X |
Addresses
Primary practice location
4000 Wake Forest Rd
Ste 200
Raleigh, NC 27609-6879
Mailing address
5171 Glenwood Ave
Suite 400
Raleigh, NC 27612-3266
Phone (919) 783-8898
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8300673 | Medicaid | NC | |
| 8300673H | Medicaid | NC | |
| 8300673A | Medicaid | NC | |
| 8300673F | Medicaid | NC | |
| 018KJ | Other | NC | NCBCBS |
| 8300673B | Medicaid | NC | |
| 8300673G | Medicaid | NC | |
| 8300673I | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| 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
National Provider DirectoryLocations
4000 Wake Forest Rd
Ste 200
Raleigh, NC 27609
Phone (919) 865-8710
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1447977600000",
"number": "1124185657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5171 GLENWOOD AVE",
"address_2": "SUITE 400",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276123266",
"telephone_number": "919-783-8898",
"fax_number": "919-782-5486"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 WAKE FOREST RD",
"address_2": "STE 200",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276096879",
"telephone_number": "919-861-1600",
"fax_number": "919-861-1637"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-03",
"last_updated": "2015-11-20",
"status": "A",
"authorized_official_last_name": "EDWARDS",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "CONTRACT ADMINISTRATOR",
"authorized_official_telephone_number": "919-783-8898",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300673",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300673H",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300673A",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300673F",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCBCBS",
"identifier": "018KJ",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300673B",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300673G",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8300673I",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
- Easter Seals Ucp North Carolina & Virginia
- Easter Seals Ucp North Carolina & Virginia
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.