Provider Demographics
NPI:1740658327
Name:EASTER SEALS, UCP
Entity type:Organization
Organization Name:EASTER SEALS, UCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MST THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:SANDREA
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCASA
Authorized Official - Phone:252-353-8001
Mailing Address - Street 1:600 LYNNDALE CT STE F
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5443
Mailing Address - Country:US
Mailing Address - Phone:252-353-8001
Mailing Address - Fax:252-353-5559
Practice Address - Street 1:600 LYNNDALE CT STE F
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5443
Practice Address - Country:US
Practice Address - Phone:252-353-8001
Practice Address - Fax:252-353-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health