Provider Demographics
NPI:1710215587
Name:PEARCE, KATINA MONIQUE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:MONIQUE
Last Name:PEARCE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 62ND ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2501
Mailing Address - Country:US
Mailing Address - Phone:443-386-9977
Mailing Address - Fax:
Practice Address - Street 1:110 PAINTERS MILL RD STE 213
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5543
Practice Address - Country:US
Practice Address - Phone:443-675-6769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-06
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15640104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker