Provider Demographics
NPI:1275047383
Name:PEARSON, PAGE LEIGH (LCSW, CTMH)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:LEIGH
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LCSW, CTMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 PASS RD STE G
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4101
Mailing Address - Country:US
Mailing Address - Phone:228-819-8818
Mailing Address - Fax:
Practice Address - Street 1:1907 PASS RD STE G
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4101
Practice Address - Country:US
Practice Address - Phone:228-819-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC78501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty