Provider Demographics
NPI:1376288191
Name:PEARSON, JULIAN ROBERT JR (MSP, MCAP)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:ROBERT
Last Name:PEARSON
Suffix:JR
Gender:M
Credentials:MSP, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 LAKESIDE DR STE 213
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3369
Mailing Address - Country:US
Mailing Address - Phone:904-389-3784
Mailing Address - Fax:904-389-4618
Practice Address - Street 1:4250 LAKESIDE DR STE 213
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3369
Practice Address - Country:US
Practice Address - Phone:904-389-3784
Practice Address - Fax:904-389-4618
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMCAP100465101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)