Provider Demographics
NPI:1821869470
Name:EDUCATION SERVICE FOR EARLY INTERVENTION
Entity Type:Organization
Organization Name:EDUCATION SERVICE FOR EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAKIA
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:SELLARS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:704-219-6512
Mailing Address - Street 1:5200 ROCKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2700
Mailing Address - Country:US
Mailing Address - Phone:704-395-0352
Mailing Address - Fax:
Practice Address - Street 1:5200 ROCKWOOD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2700
Practice Address - Country:US
Practice Address - Phone:704-395-0352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency