Provider Demographics
NPI:1720428295
Name:PEARSON, MICHAEL CEDELL (LCSWA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CEDELL
Last Name:PEARSON
Suffix:
Gender:M
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-4725
Mailing Address - Country:US
Mailing Address - Phone:336-949-7685
Mailing Address - Fax:
Practice Address - Street 1:2806 AZALEA DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-4725
Practice Address - Country:US
Practice Address - Phone:336-949-7685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0078601041C0700X, 1041S0200X, 1041S0200X
NCPO15578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool