Shereese Nicole Pearsall

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

APC002994 Issued in GA

Practice address

170 Bastille Way
Fayetteville, GA 30214-7652

Phone

(770) 255-9941

NPI assigned

Feb 13, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, GA, CO, OR, RI5 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 5

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  CO, GA, OR, Professional, RI

  Medicare reassignment NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Professional

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1528307394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 NORTHWIND LN",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816255",
            "telephone_number": "404-731-8930",
            "fax_number": "770-629-4071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 BASTILLE WAY",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147652",
            "telephone_number": "770-255-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSALL",
        "first_name": "SHEREESE",
        "middle_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-13",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC002994",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "CA",
            "license": "LPCC15234",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peach Fits,Inc
• Peachtree Detox LLC
• Peachtree Fayette Women'S Specialists
• Peachtree Women'S Physical Therapy, Inc
• Gretchen H Peacock, DMFT
• Kelly Haskell Peczka
• Pediatric Emergency Medicine Associates LLC
• Matthew Pedrotti, DPT
• Kayla Peeples, OT
• David Parker Pendergrast, RPH

• Professional Counselor in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.