Provider Demographics
NPI:1902538846
Name:PEARSON, DOUGLAS EUGENE (OPCC-S, CDCA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EUGENE
Last Name:PEARSON
Suffix:
Gender:M
Credentials:OPCC-S, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-2136
Mailing Address - Country:US
Mailing Address - Phone:330-253-8803
Mailing Address - Fax:
Practice Address - Street 1:834 GRANT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-2136
Practice Address - Country:US
Practice Address - Phone:330-253-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.001768175T00000X
OHCDCA.179270101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)