Provider Demographics
NPI:1841592631
Name:PIERCE, MARY ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 GRAYBEAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9730
Mailing Address - Country:US
Mailing Address - Phone:336-620-9179
Mailing Address - Fax:336-219-0110
Practice Address - Street 1:418 MOUNT PADDY RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-9159
Practice Address - Country:US
Practice Address - Phone:336-620-6179
Practice Address - Fax:336-219-0110
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional