Provider Demographics
NPI:1093953721
Name:PECK, DIANA GAY (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:GAY
Last Name:PECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 PROSPECT DR # 10-88
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-9311
Mailing Address - Country:US
Mailing Address - Phone:209-217-6657
Mailing Address - Fax:209-754-9604
Practice Address - Street 1:14204 OLD HWY 49
Practice Address - Street 2:SUITE 11
Practice Address - City:AMADOR
Practice Address - State:CA
Practice Address - Zip Code:95601
Practice Address - Country:US
Practice Address - Phone:209-217-6657
Practice Address - Fax:209-223-3356
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical