| Easter Seals Ucp North Carolina & Virginia, Inc. | |
|
4000 Wake Forest Rd Ste 200 Raleigh NC 27609 | |
| (919) 783-8898 | |
| (919) 782-5486 |
| Full Name | Easter Seals Ucp North Carolina & Virginia, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4000 Wake Forest Rd, Raleigh, North Carolina |
| Authorized Official Name and Position | Brett Beavers (CREDENTIALING MANAGER) |
| Authorized Official Contact | 9192107661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Easter Seals Ucp North Carolina & Virginia, Inc. 5171 Glenwood Ave Suite 211 Raleigh NC 27612-3266 Ph: (919) 783-8898 | Easter Seals Ucp North Carolina & Virginia, Inc. 4000 Wake Forest Rd Ste 200 Raleigh NC 27609 Ph: (919) 783-8898 |
| NPI Number | 1306167713 |
|---|---|
| Provider Enumeration Date | 06/21/2010 |
| Last Update Date | 05/02/2024 |
| Certification Date | 05/02/2024 |
| Medicare PECOS PAC ID | 7618161407 |
|---|---|
| Medicare Enrollment ID | O20101105000534 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306167713 | NPI | - | NPPES |
| 8300673 | Medicaid | NC | |
| 8300676 | Medicaid | NC | |
| 8301327 | Medicaid | NC | |
| 8301523 | Medicaid | NC | |
| 8300675 | Medicaid | NC | |
| 8300746 | Medicaid | NC | |
| 8301522 | Medicaid | NC | |
| 8300672 | Medicaid | NC | |
| 8300709 | Medicaid | NC | |
| 8300488 | Medicaid | NC |
| Provider Name | Alexia Sandra Maneschi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417000381 PECOS PAC ID: 6406865609 Enrollment ID: I20060417000632 |
| Provider Name | Mandy Wilson Gravitte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730415894 PECOS PAC ID: 0840339396 Enrollment ID: I20091123000569 |
| Provider Name | Phyllis Sage Atwell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548270325 PECOS PAC ID: 4587611249 Enrollment ID: I20100510000645 |
| Provider Name | Frantz E Pierre |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710168042 PECOS PAC ID: 4587844188 Enrollment ID: I20110215000405 |
| Provider Name | Vinay Paran Saranga |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144428673 PECOS PAC ID: 9739361718 Enrollment ID: I20120816000826 |
| Provider Name | Ajay Bankim Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568830529 PECOS PAC ID: 0547540619 Enrollment ID: I20161206002557 |
| Provider Name | Jozef Zelenak |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225393663 PECOS PAC ID: 3375817125 Enrollment ID: I20170919000100 |
| Provider Name | Alison R Voyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447659321 PECOS PAC ID: 1850656570 Enrollment ID: I20180530002716 |
| Provider Name | Nicole Ann Stoneback |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720646227 PECOS PAC ID: 9133451966 Enrollment ID: I20191029001215 |
| Provider Name | Jason Radosevich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750792800 PECOS PAC ID: 0648606806 Enrollment ID: I20200206000449 |
| Provider Name | Amy Drozda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760515688 PECOS PAC ID: 2466530621 Enrollment ID: I20210304001679 |
| Provider Name | Courtney Nichole Barrett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992041529 PECOS PAC ID: 3971988213 Enrollment ID: I20220922000996 |
| Provider Name | Tyisha Tamar Teel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992281349 PECOS PAC ID: 5496121337 Enrollment ID: I20221018003489 |
| Provider Name | Kathryn Christina Lane |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164096913 PECOS PAC ID: 0143671578 Enrollment ID: I20240110000113 |
| Provider Name | Laura Smith Toptine |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326512724 PECOS PAC ID: 1456702893 Enrollment ID: I20240110000394 |
| Provider Name | Amanda Eileen Schaefer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730832916 PECOS PAC ID: 5799136164 Enrollment ID: I20240110001796 |
| Provider Name | Condalette Stone Artero |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821589813 PECOS PAC ID: 1355792771 Enrollment ID: I20240110003642 |
| Provider Name | Charles Thomas Dixon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992173363 PECOS PAC ID: 4486005741 Enrollment ID: I20240110005163 |
| Provider Name | Zackary Terry Hawks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164776118 PECOS PAC ID: 1456702729 Enrollment ID: I20240111000342 |
| Provider Name | Isaac Ja-varas Everette |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649640046 PECOS PAC ID: 7113378217 Enrollment ID: I20240112000885 |
| Provider Name | Tonya Carol Oakley |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1417007733 PECOS PAC ID: 0345692232 Enrollment ID: I20240116003423 |
| Provider Name | Misty L. Cooke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780069815 PECOS PAC ID: 1759733561 Enrollment ID: I20240117002882 |
| Provider Name | Rolando Rodriguez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215478292 PECOS PAC ID: 1557713146 Enrollment ID: I20240118004699 |
| Provider Name | Allison Yost |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225654387 PECOS PAC ID: 0143672774 Enrollment ID: I20240119001255 |
| Provider Name | Negin Ghofrany Kempf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629734975 PECOS PAC ID: 5294187647 Enrollment ID: I20240122001283 |
| Provider Name | Tereaka Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669064754 PECOS PAC ID: 9133566581 Enrollment ID: I20240321002080 |
| Provider Name | Jolina Gayle Bild |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538772918 PECOS PAC ID: 6406294966 Enrollment ID: I20240402004383 |
| Provider Name | Linda Cheryl Jacobs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841493533 PECOS PAC ID: 3678911138 Enrollment ID: I20240402004413 |
| Provider Name | Megan Ashley Wingate |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1194002709 PECOS PAC ID: 3577901032 Enrollment ID: I20240402004435 |
| Provider Name | Amy Skinner Ranard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548448293 PECOS PAC ID: 8325487937 Enrollment ID: I20240416001474 |
| Provider Name | Gwendolyn Long Roberts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720318082 PECOS PAC ID: 1355781212 Enrollment ID: I20240425004085 |
| Provider Name | Geneva Nicole Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467983726 PECOS PAC ID: 4385186287 Enrollment ID: I20240606003114 |
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