| Organization Name: | EASTER SEALS UCP NORTH CAROLINA & VIRGINIA, INC. |
| NPI Number: | 1104988047 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD P EDWARDS (CONTRACT ADMINISTRATOR) |
| Mailing Address: | 414 W Lebanon St Mount Airy |
| State: | NC US |
| Postal Code: | 270302954 |
| Phone Number: | 3367899492 |
| Fax Number: | 3367899587 |
| NPI Enumeration Date: | 12/15/2006 |
| NPI Last Update Date: | 12/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |