Provider Demographics
NPI:1871795229
Name:PEARSON, SANDRA DARNELL (BA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DARNELL
Last Name:PEARSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10625 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39565-8349
Mailing Address - Country:US
Mailing Address - Phone:228-396-2672
Mailing Address - Fax:
Practice Address - Street 1:2020 HARDY ST STE A2
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4941
Practice Address - Country:US
Practice Address - Phone:601-544-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor