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General NPI Number Information
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NPI Number | 1528307394
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Entity Type | Individual
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Provider Name | SHEREESE NICOLE PEARSALL
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Gender | Female
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 170 BASTILLE WAY
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7652
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Country | US
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Telephone | 770-255-9941
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Fax |
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Provider Business Mailing Address
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Address Line | 612 NORTHWIND LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6255
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Country | US
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Telephone | 404-731-8930
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Fax | 770-629-4071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | APC002994
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCC15234
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License Number State | CA
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