Provider Demographics
NPI:1346423589
Name:PEARSON, MIRANDA YVONNE (LPC,NCC,BCC,LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:YVONNE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LPC,NCC,BCC,LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-5108
Mailing Address - Country:US
Mailing Address - Phone:919-464-4255
Mailing Address - Fax:919-894-8036
Practice Address - Street 1:401 S MARKET ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1725
Practice Address - Country:US
Practice Address - Phone:919-894-8002
Practice Address - Fax:919-894-8036
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6777101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103779Medicaid