Easter Seals Ucp North Carolina & Virginia, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.

Practice address

913 N Carolina Ave
Statesville, NC 28677-3414

Phone

(704) 402-1060

Fax

(704) 402-1065

NPI assigned

Dec 15, 2006

Last updated

Aug 17, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nasheba Key-Allred

Title

Credentialing Specialist

Phone

(919) 865-8632

Specialties & licenses 3

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christina Shelby Boland, LCSW

  • Clinical Social Worker
  • Statesville, NC
  • NPI 1043961675
  NPD
• Charles Thomas Dixon, M.S., NCC, LPCA

  • Mental Health Counselor
  • Statesville, NC
  • NPI 1992173363
  NPD
• Amy D Drozda, MSW, LCSW

  • Clinical Social Worker
  • Goldsboro, NC
  • NPI 1760515688
  NPD
• Russell Meyers, LCAS-A

  • Addiction (Substance Use Disorder) Counselor
  • Pine Knoll Shores, NC
  • NPI 1235676743
  NPD
• Joshua Joel Pagano, D.O.

  • Psychiatry Physician
  • Goldsboro, NC
  • NPI 1689995730
  NPD
• Bre'Anna Nicole Williams, LCSW-A

  • Clinical Social Worker
  • Statesville, NC
  • NPI 1710612916
  NPD
• Michael Dean Culler, PA

  • Physician Assistant
  • Mount Airy, NC
  • NPI 1053424598
  NPD (past)
• Zackary Terry Hawks, MA

  • Professional Counselor
  • Mount Airy, NC
  • NPI 1164776118
  NPD (past)
• Julie Brandenburg McDowell, PA

  • Physician Assistant
  • Mount Airy, NC
  • NPI 1033232277
  NPD (past)
• Tonya Carol Oakley, M.A.,L.M.F.T

  • Marriage & Family Therapist
  • Mount Airy, NC
  • NPI 1417007733
  NPD (past)
• Megan Ashley Wingate, MS, LMFT

  • Marriage & Family Therapist
  • Raleigh, NC
  • NPI 1194002709
  NPD (past)
• Jozef Zelenak, MD

  • Psychiatry Physician
  • Raleigh, NC
  • NPI 1225393663
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1942362884",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 N CAROLINA AVE",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773414",
            "telephone_number": "704-402-1060",
            "fax_number": "704-402-1065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "414 W Lebanon St",
            "address_purpose": "LOCATION",
            "city": "Mount Airy",
            "state": "NC",
            "postal_code": "270302954",
            "country_code": "US",
            "telephone_number": "336-789-9492",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4000 Wake Forest Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276096859",
            "country_code": "US",
            "telephone_number": "919-865-8710",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "619 Sullivan Rd",
            "address_purpose": "LOCATION",
            "city": "Statesville",
            "state": "NC",
            "postal_code": "286773437",
            "country_code": "US",
            "telephone_number": "704-871-0934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "KEY-ALLRED",
        "authorized_official_first_name": "NASHEBA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "919-865-8632"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675I",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675G",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BCBS",
            "identifier": "018KJ",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675H",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675F",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300675A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Easter Seals Ucp
• 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.
• Eastersealsucp-Asap Inc (Area Services and Programs Inc)
• Lee Hunter Easterwood, M.D.
• Eastside Pharmacy Services LLC (Banner Drug)
• Eastside Pharmacy Services LLC (Banner Drug Co)

• Community/Behavioral Health Agency in Statesville, NC
• Providers in Statesville, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.

Verify at the official NPI Registry.