Provider Demographics
NPI:1245763184
Name:PEARSON, PAM GENISE
Entity Type:Individual
Prefix:MISS
First Name:PAM
Middle Name:GENISE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10529 BARVAS ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1524
Mailing Address - Country:US
Mailing Address - Phone:704-717-7939
Mailing Address - Fax:704-717-7939
Practice Address - Street 1:421 FAYETTEVILLE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1792
Practice Address - Country:US
Practice Address - Phone:954-947-3749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician