Provider Demographics
NPI:1164114187
Name:PEACOCK, ALEXIS J
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 LILY PAD LN
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9503
Mailing Address - Country:US
Mailing Address - Phone:828-220-4224
Mailing Address - Fax:
Practice Address - Street 1:447 LILY PAD LN
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9503
Practice Address - Country:US
Practice Address - Phone:828-220-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17735101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor