Easter Seals Ucp North Carolina & Virginia, Inc.
Organization Active NPI Mental Health Counselor · Statesville, NC
NPI 1962556852 · NPPES record last updated Nov 23, 2010
Key facts
- NPI
- 1962556852
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC.
- Practice address
- 913 N Carolina Ave
Statesville, NC 28677-3414 - Phone
- (704) 871-1045
- Fax
- (704) 883-8638
- NPI assigned
- Jan 22, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Richard P Edwards
- Title
- Vice President
- Phone
- (919) 783-8898
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes |
Addresses
Primary practice location
913 N Carolina Ave
Statesville, NC 28677-3414
Mailing address
5171 Glenwood Ave
Suite 400
Raleigh, NC 27612-3266
Phone (919) 783-8898
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2345163A | Other | NC | MEDICARE |
| 6005987 | Medicaid | NC |
Other providers in Statesville, NC
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
- Easter Seals Ucp North Carolina & Virginia, Inc.
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All providers in Statesville, NC · Mental Health Counselor 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 Nov 23, 2010. 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.