Provider Demographics
NPI:1427374404
Name:COAKLEY, PEARL AILSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PEARL
Middle Name:AILSA
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:AILSA
Other - Middle Name:
Other - Last Name:COAKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4230 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4291
Mailing Address - Country:US
Mailing Address - Phone:301-399-9119
Mailing Address - Fax:
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:SUITE 320
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-399-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000044103TC0700X
MD03437103TC0700X
VA0810000357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical