Provider Demographics
NPI:1407044779
Name:EASTER SEALS UCP ASAP INC.
Entity Type:Organization
Organization Name:EASTER SEALS UCP ASAP INC.
Other - Org Name:AREA SERVICES AND PROGRAMS INCE.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SUPPORT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:G
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-865-8772
Mailing Address - Street 1:3801 LAKE BOONE TRAIL
Mailing Address - Street 2:SUITE 320
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-865-8772
Mailing Address - Fax:919-784-9184
Practice Address - Street 1:339 WALL ST
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-9382
Practice Address - Country:US
Practice Address - Phone:336-694-4333
Practice Address - Fax:336-694-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301522AMedicaid
NC8301522BMedicaid