Provider Demographics
NPI:1912163254
Name:PEARCE, KIMBER CHARLES (MS, LPC, LCAS, CRC)
Entity Type:Individual
Prefix:MR
First Name:KIMBER
Middle Name:CHARLES
Last Name:PEARCE
Suffix:
Gender:M
Credentials:MS, LPC, LCAS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TARPON TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5287
Mailing Address - Country:US
Mailing Address - Phone:910-938-1114
Mailing Address - Fax:910-938-1118
Practice Address - Street 1:200 TARPON TRL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5287
Practice Address - Country:US
Practice Address - Phone:910-938-1114
Practice Address - Fax:910-938-1118
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1297101YA0400X
NC7036101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103995Medicaid
NC444429OtherTRICARE MHN
NC1525JOtherBLUE CROSS BLUE SHIELD