Provider Demographics
NPI:1578981528
Name:PEARSON, CHRISTINE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BIRKET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8254 118TH AVENUE N
Mailing Address - Street 2:STE 100
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5260 COQUINA KEY DR SE
Practice Address - Street 2:APT. C
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-6335
Practice Address - Country:US
Practice Address - Phone:310-467-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-13-5510103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019637000Medicaid