Provider Demographics
NPI:1174693717
Name:PEARSON, RENEE (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3843
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-1843
Mailing Address - Country:US
Mailing Address - Phone:252-355-5587
Mailing Address - Fax:252-355-0388
Practice Address - Street 1:102 REGENCY BLVD STE B5
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4666
Practice Address - Country:US
Practice Address - Phone:252-355-5587
Practice Address - Fax:252-355-0388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0038841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002610Medicaid
NC6002610Medicaid