Provider Demographics
NPI:1700338589
Name:PEARSON, LOSSIE SHEVETTA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LOSSIE
Middle Name:SHEVETTA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17356 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2128
Mailing Address - Country:US
Mailing Address - Phone:313-682-9071
Mailing Address - Fax:
Practice Address - Street 1:17356 W. 12 MILE SUITE 203
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:313-682-9071
Practice Address - Fax:248-562-7119
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008883101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor