Provider Demographics
NPI:1679018113
Name:PEARSON, ANGELA LYNN (SUDP, AAC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:SUDP, AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21107 ELBERTA RD # 2
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8658
Mailing Address - Country:US
Mailing Address - Phone:206-678-6434
Mailing Address - Fax:
Practice Address - Street 1:21107 ELBERTA RD # 2
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-8658
Practice Address - Country:US
Practice Address - Phone:206-678-6434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60223891101YM0800X
WACP60344301101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)