Provider Demographics
NPI:1770640203
Name:EASTER SEALS UCP ASAP INC
Entity Type:Organization
Organization Name:EASTER SEALS UCP ASAP INC
Other - Org Name:ASAP
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:SULLIVAN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-784-9182
Mailing Address - Street 1:3801 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-2934
Mailing Address - Country:US
Mailing Address - Phone:919-784-9182
Mailing Address - Fax:919-784-9184
Practice Address - Street 1:134 WIND CHIME CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6433
Practice Address - Country:US
Practice Address - Phone:919-784-9182
Practice Address - Fax:919-784-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018KJOtherNC BCBS
NC6005830Medicaid
NC018KJOtherNC BCBS