Active NPI
Kimber Charles Pearce, MS, LPC, LCAS, CRC
- Professional Counselor
- Jacksonville, NC
National Provider Identifier
1912163254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 7036
- Practice address
- 200 Tarpon TRL
Jacksonville, NC 28546-5287 - Phone
- (910) 938-1114
- Fax
- (910) 938-1118
- NPI assigned
- Aug 6, 2008
- Last updated
- Apr 4, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1297 | NC | |
| Mental Health Counselor | 101YM0800X | 7036 | NC | |
| Professional Counselor | 101YP2500X | 7036 | NC | Primary |
Addresses
Primary practice location
200 Tarpon TRL
Jacksonville, NC 28546-5287
Mailing address
200 Tarpon TRL
Jacksonville, NC 28546-5287
Phone (910) 938-1114
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6103995 | Medicaid | NC | |
| 444429 | Other | NC | TRICARE MHN |
| 1525J | Other | NC | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7036 | NC | MD | Professional Counselor |
| 1297 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365033600000",
"number": "1912163254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 TARPON TRL",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285465287",
"telephone_number": "910-938-1114",
"fax_number": "910-938-1118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 TARPON TRL",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285465287",
"telephone_number": "910-938-1114",
"fax_number": "910-938-1118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEARCE",
"first_name": "KIMBER",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "MS, LPC, LCAS, CRC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-08-06",
"last_updated": "2013-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NC",
"license": "1297",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "7036",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "7036",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6103995",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE MHN",
"identifier": "444429",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1525J",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.