Provider Demographics
NPI:1306550256
Name:PEARSON, JAMIE MOORE (DSW, MSW, LCSW-A)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:MOORE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:DSW, MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 TOURNAMENT DR APT 306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2599
Mailing Address - Country:US
Mailing Address - Phone:828-764-5253
Mailing Address - Fax:
Practice Address - Street 1:130 IOWA LN STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-2401
Practice Address - Country:US
Practice Address - Phone:919-585-5085
Practice Address - Fax:919-585-5085
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0184411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical