Provider Demographics
NPI:1700813870
Name:PEARCE, JEFFREY C (MED)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:PEARCE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 WINDY HILL DR STE A
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5196
Mailing Address - Country:US
Mailing Address - Phone:919-781-8161
Mailing Address - Fax:
Practice Address - Street 1:4922 WINDY HILL DR STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5196
Practice Address - Country:US
Practice Address - Phone:919-781-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional