| Easter Seals Ucp North Carolina & Virginia, Inc. | |
|
3801 Lake Boone Trl Raleigh NC 27607-2934 | |
| (919) 783-8898 | |
| (919) 786-1588 |
| Full Name | Easter Seals Ucp North Carolina & Virginia, Inc. |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3801 Lake Boone Trl, Raleigh, 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. 3801 Lake Boone Trl Raleigh NC 27607-2934 Ph: (919) 783-8898 |
| NPI Number | 1659433993 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 11/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659433993 | NPI | - | NPPES |
| 8300488H | Medicaid | NC | |
| 8300488I | Medicaid | NC | |
| 018KJ | Other | NC | WAKECIS |
| 8300488F | Medicaid | NC | |
| 8300488 | Medicaid | NC | |
| 8300488A | Medicaid | NC | |
| 8300488B | Medicaid | NC | |
| 8300488G | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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