Provider Demographics
NPI:1497181473
Name:LAVERY, PEARLE (LCAS)
Entity Type:Individual
Prefix:
First Name:PEARLE
Middle Name:
Last Name:LAVERY
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2909 ARMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4603
Mailing Address - Country:US
Mailing Address - Phone:336-350-8169
Mailing Address - Fax:
Practice Address - Street 1:530 ROSENWALD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2468
Practice Address - Country:US
Practice Address - Phone:336-350-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-22
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)