Provider Demographics
NPI:1992360358
Name:PEARSON, MIKA ELANI (LAPC)
Entity Type:Individual
Prefix:
First Name:MIKA
Middle Name:ELANI
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BURKETTS FERRY RD APT E2
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-7137
Mailing Address - Country:US
Mailing Address - Phone:912-253-6111
Mailing Address - Fax:
Practice Address - Street 1:9420 BLACKSHEAR HWY
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-5715
Practice Address - Country:US
Practice Address - Phone:912-367-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional