Provider Demographics
NPI:1073007118
Name:PIERCE, MICHAEL SCOTT (CSP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:PIERCE
Suffix:
Gender:M
Credentials:CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 TWIN PINES RD
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-4956
Mailing Address - Country:US
Mailing Address - Phone:910-212-8292
Mailing Address - Fax:
Practice Address - Street 1:411 W HAMPTON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3337
Practice Address - Country:US
Practice Address - Phone:843-765-4087
Practice Address - Fax:843-765-4085
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician