Healthcare Provider Details

I. General information

NPI: 1225894066
Provider Name (Legal Business Name): CODY PEARSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9833 PATRIOT HWY
FREDERICKSBURG VA
22407-9422
US

IV. Provider business mailing address

906 FORBES ST
FREDERICKSBURG VA
22405-2017
US

V. Phone/Fax

Practice location:
  • Phone: 540-710-3911
  • Fax:
Mailing address:
  • Phone: 540-710-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number21-164927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: