| Easter Seals Ucp North Carolina & Virginia, Inc. | |
|
351 Wagoner Dr Ste 160 Fayetteville NC 28303-4608 | |
| (919) 861-1600 | |
| (919) 861-1637 |
| Full Name | Easter Seals Ucp North Carolina & Virginia, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 351 Wagoner Dr Ste 160, Fayetteville, North Carolina |
| Authorized Official Name and Position | Richard P Edwards (VICE PRESIDENT) |
| Authorized Official Contact | 9197838898 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Easter Seals Ucp North Carolina & Virginia, Inc. 5171 Glenwood Ave Suite 400 Raleigh NC 27612-3266 Ph: (919) 783-8898 | Easter Seals Ucp North Carolina & Virginia, Inc. 351 Wagoner Dr Ste 160 Fayetteville NC 28303-4608 Ph: (919) 861-1600 |
| NPI Number | 1164584009 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 06/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164584009 | NPI | - | NPPES |
| 6005830 | Medicaid | NC | |
| 018KJ | Other | NC | NC BCBS GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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