Provider Demographics
NPI:1720365729
Name:BALDWIN, ULYSSES GRANT JR (MSW, LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:ULYSSES
Middle Name:GRANT
Last Name:BALDWIN
Suffix:JR
Gender:M
Credentials:MSW, LCAS-A
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Mailing Address - Street 1:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27802-2723
Mailing Address - Country:US
Mailing Address - Phone:252-212-3350
Mailing Address - Fax:252-212-0322
Practice Address - Street 1:90 GUARDIAN CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3017
Practice Address - Country:US
Practice Address - Phone:252-212-3350
Practice Address - Fax:252-212-0322
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2956-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)