Provider Demographics
NPI:1558521872
Name:PEARCE, SHANNON (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SUBARICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1401 MALVERN AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-6377
Mailing Address - Country:US
Mailing Address - Phone:501-701-8492
Mailing Address - Fax:
Practice Address - Street 1:1401 MALVERN AVE STE 260
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71901-6377
Practice Address - Country:US
Practice Address - Phone:501-701-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2518-C101YM0800X, 101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
291589YJ5BMedicare UPIN