Provider Demographics
NPI:1851779011
Name:PEARCE, TINA RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:PEARCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 HIGHWAY 62 65 N STE 2
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-1970
Mailing Address - Country:US
Mailing Address - Phone:479-304-8741
Mailing Address - Fax:
Practice Address - Street 1:7349 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72682-9998
Practice Address - Country:US
Practice Address - Phone:479-304-8741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7219-M104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR7219-COtherLCSW