Provider Demographics
NPI:1699077958
Name:PEARSON, MELANIE DENISE (RRW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:DENISE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 W COMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3110
Mailing Address - Country:US
Mailing Address - Phone:310-603-6555
Mailing Address - Fax:310-603-6565
Practice Address - Street 1:369 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3110
Practice Address - Country:US
Practice Address - Phone:310-603-6555
Practice Address - Fax:310-603-6565
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW3580101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)