Provider Demographics
NPI:1306044656
Name:CONGDON, PEGGIE DUNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGIE
Middle Name:DUNE
Last Name:CONGDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PEGGIE DUNE
Other - Middle Name:ANNE
Other - Last Name:RABE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:255 MAPLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1009
Mailing Address - Country:US
Mailing Address - Phone:832-767-3600
Mailing Address - Fax:
Practice Address - Street 1:255 MAPLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-1009
Practice Address - Country:US
Practice Address - Phone:832-767-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX264711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611708OtherMEDICARE PROVIDER NUMBER