Healthcare Provider Details

I. General information

NPI: 1720428295
Provider Name (Legal Business Name): MICHAEL CEDELL PEARSON LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2806 AZALEA DR
GREENSBORO NC
27407-4725
US

IV. Provider business mailing address

2806 AZALEA DR
GREENSBORO NC
27407-4725
US

V. Phone/Fax

Practice location:
  • Phone: 336-949-7685
  • Fax:
Mailing address:
  • Phone: 336-949-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPO15578
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP007860
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberP007860
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: