Provider Demographics
NPI:1194041962
Name:PETON, ALICIA IVANA (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:IVANA
Last Name:PETON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-2234
Mailing Address - Country:US
Mailing Address - Phone:919-480-0101
Mailing Address - Fax:
Practice Address - Street 1:6815 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7080
Practice Address - Country:US
Practice Address - Phone:919-523-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health