Provider Demographics
NPI:1093468001
Name:PEARSON, QUINCY DE'ANGELO
Entity Type:Individual
Prefix:
First Name:QUINCY
Middle Name:DE'ANGELO
Last Name:PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 HARGROVE RD E APT 306
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3432
Mailing Address - Country:US
Mailing Address - Phone:205-457-4624
Mailing Address - Fax:
Practice Address - Street 1:2703 7TH ST
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1865
Practice Address - Country:US
Practice Address - Phone:205-723-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5561G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker