Provider Demographics
NPI:1962797001
Name:PEARSALL, KIMBERLY CROCKER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CROCKER
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 S FLORIDA AVE
Mailing Address - Street 2:#408
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2537
Mailing Address - Country:US
Mailing Address - Phone:863-648-0313
Mailing Address - Fax:863-648-0335
Practice Address - Street 1:5130 S FLORIDA AVE
Practice Address - Street 2:#408
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2537
Practice Address - Country:US
Practice Address - Phone:863-648-0313
Practice Address - Fax:863-648-0335
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW90291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical