Provider Demographics
NPI:1215286653
Name:AYCOCK, KATHERINE PEARSON (MA/CAS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:PEARSON
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:MA/CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BELLE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8387
Mailing Address - Country:US
Mailing Address - Phone:919-801-4864
Mailing Address - Fax:
Practice Address - Street 1:310 BELLE OAKS DR
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-8387
Practice Address - Country:US
Practice Address - Phone:919-801-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool