MEDICARE: SELDOM PEARCE SUDP/T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO61616856	WA

General Provider Information

NPI Number	:	1144030032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELDOM PEARCE SUDP/T

Provider Business Mailing Address
First Line	:	2411 WEST ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-2152
Country	:	US
Telephone Number	:	360-815-2415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 GIRARD ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-3219
Country	:	US
Telephone Number	:	360-397-8246
Fax Number	:	360-656-6540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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