Provider Demographics
NPI:1154977924
Name:PEARSON, VICTORIA JO-EL (LMHC, CASAC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:JO-EL
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13038 146TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-2307
Mailing Address - Country:US
Mailing Address - Phone:347-624-4623
Mailing Address - Fax:917-725-6210
Practice Address - Street 1:130-38 146 STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436
Practice Address - Country:US
Practice Address - Phone:347-624-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26226101Y00000X
NY18001434-00101YM0800X
NY010054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY26226OtherNYS OFFICE OF ALCOHOLISM ANDSUBSTANCE ABUSE SERVICES
NY010054OtherNEW YORK STATE OFFICE OF PROFESSIONS