Provider Demographics
NPI:1407232523
Name:GODFREY, PETER (LCSW, LCAS, CSI)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:GODFREY
Suffix:
Gender:M
Credentials:LCSW, LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 TUNNEL RD STE F
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1869
Mailing Address - Country:US
Mailing Address - Phone:828-423-2669
Mailing Address - Fax:828-774-5726
Practice Address - Street 1:119 TUNNEL RD STE F
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1869
Practice Address - Country:US
Practice Address - Phone:828-423-2669
Practice Address - Fax:828-774-5726
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-20068101YA0400X
NCC0097001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)