Provider Demographics
NPI:1174003354
Name:PEARCE, GINA VICTORIA (LCMHC, LADC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:VICTORIA
Last Name:PEARCE
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 PAKO AVE
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-5023
Mailing Address - Country:US
Mailing Address - Phone:802-579-2420
Mailing Address - Fax:
Practice Address - Street 1:1 ANNA MARSH LANE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05302
Practice Address - Country:US
Practice Address - Phone:802-258-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT151.0127842101YA0400X
VT068.0084548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)