Provider Demographics
NPI:1437259207
Name:BLAIR-AIKEN, PEARL
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:
Last Name:BLAIR-AIKEN
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 1:1547 PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4081
Mailing Address - Country:US
Mailing Address - Phone:864-229-7120
Mailing Address - Fax:864-229-5526
Practice Address - Street 1:209 PEACHTREE STREET
Practice Address - Street 2:
Practice Address - City:MCCORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835
Practice Address - Country:US
Practice Address - Phone:864-465-2090
Practice Address - Fax:864-465-3325
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0065911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421504Medicaid
3340Medicare ID - Type Unspecified