Provider Demographics
NPI:1083386130
Name:PEACOCK, ALEXIS MARIA (LMSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIA
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3957
Mailing Address - Country:US
Mailing Address - Phone:240-500-0481
Mailing Address - Fax:
Practice Address - Street 1:810 MULBERRY AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3957
Practice Address - Country:US
Practice Address - Phone:240-500-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health