Provider Demographics
NPI:1538228770
Name:PEARL, WILLIAM J (LCSW, LPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:PEARL
Suffix:
Gender:M
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5003
Mailing Address - Country:US
Mailing Address - Phone:304-723-5440
Mailing Address - Fax:304-723-0665
Practice Address - Street 1:501 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5003
Practice Address - Country:US
Practice Address - Phone:304-723-5440
Practice Address - Fax:304-723-0665
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCP00455139104100000X
WV199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000145928OtherMOUNTAIN STATE BCBS
WV172723OtherTRICARE
WV2070075OtherCIGNA
WVY141569OtherHEALTH PLAN
WV0005456001Medicaid
WV243490000OtherMAGELLAN MIS NUMBER
WVY141569OtherHEALTH PLAN