Individual
MR. KENNETH PEARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPA
Contact information
Practice address
1703 COUNTRY CLUB RD, SUITE 204, JACKSONVILLE, NC 28546
(910) 347-3010
(910) 347-3201
Mailing address
1703 COUNTRY CLUB RD, SUITE 204, JACKSONVILLE, NC 28546
(910) 347-3010
(910) 347-3201
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2269
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141U1
BC/BS
NC
05
—
6107133
—
NC
Enumeration date
01/03/2006
Last updated
05/08/2008
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