Provider Demographics
NPI:1144030032
Name:PEARCE, SELDOM (SUDP/T)
Entity type:Individual
Prefix:
First Name:SELDOM
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:SUDP/T
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDP/T
Mailing Address - Street 1:2411 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2152
Mailing Address - Country:US
Mailing Address - Phone:360-815-2415
Mailing Address - Fax:
Practice Address - Street 1:1211 GIRARD ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3219
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:360-656-6540
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61616856101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)