34D2034443 CLIA NUMBER - EASTER SEALS UCP NORTH CAROLINA & VIRGINIA MT. AIRY STAY WELL INTEGRATED CARE PROGRAM

Laboratory Demographics

  • CLIA Code: 34D2034443
  • Facility Name: EASTER SEALS UCP NORTH CAROLINA & VIRGINIA MT. AIRY STAY WELL INTEGRATED CARE PROGRAM
  • Facility Address: 414 WEST LEBANNON STREET
    MT AIRY, NC
    ZIP 27030
  • Facility Phone: 336 786-7079
  • Facility Type: Other - INTEGRATED CARE CLINIC
  • Facility Type: Waiver
  • Lab Director: MS. SHANNON SANDERS
  • NPI Number: 1194887695
  • Taxonomy: 101YM0800X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 34D2034443
LAB Type Other - INTEGRATED CARE CLINIC
Facility Name EASTER SEALS UCP NORTH CAROLINA & VIRGINIA MT. AIRY STAY WELL INTEGRATED CARE PROGRAM
Street 414 WEST LEBANNON STREET
City MT AIRY
State NC
ZIP 27030
Phone 336 786-7079
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Other - INTEGRATED CARE CLINIC
Lab Director MS. SHANNON SANDERS

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This page was last updated on: 9/29/2025