Provider Demographics
NPI:1043381452
Name:MOREHOUSE, PEGGY K (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:K
Last Name:MOREHOUSE
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HAMMOND DR NE
Mailing Address - Street 2:BLDG 4 SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5532
Mailing Address - Country:US
Mailing Address - Phone:770-390-9734
Mailing Address - Fax:770-395-1243
Practice Address - Street 1:750 HAMMOND DR NE
Practice Address - Street 2:BLDG 4 SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5532
Practice Address - Country:US
Practice Address - Phone:770-390-9734
Practice Address - Fax:770-395-1243
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW # 2011041C0700X
GALMFT #405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA492787OtherBCBS GA
GA80BBCBRMedicare ID - Type Unspecified