Provider Demographics
NPI:1043999089
Name:PEARCE, AUSTIN GARRETT (MED, LCMHC-A)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:GARRETT
Last Name:PEARCE
Suffix:
Gender:M
Credentials:MED, LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 GODWIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-6339
Mailing Address - Country:US
Mailing Address - Phone:919-602-9212
Mailing Address - Fax:
Practice Address - Street 1:936 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5518
Practice Address - Country:US
Practice Address - Phone:919-701-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty