Provider Demographics
NPI:1265443139
Name:STUDSTILL-HORANSKY, PEGGY A (LCSW)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:STUDSTILL-HORANSKY
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 1:335 DASHING WAVE LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4232
Mailing Address - Country:US
Mailing Address - Phone:770-772-6103
Mailing Address - Fax:
Practice Address - Street 1:3912 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7339
Practice Address - Country:US
Practice Address - Phone:770-414-9742
Practice Address - Fax:770-414-8296
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0006851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA673896658AMedicaid
GA673896658AMedicaid
GA80BBFWZMedicare ID - Type Unspecified