Provider Demographics
NPI:1467142646
Name:PECK, FAITH (BCBA)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 HUTTON BR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4266
Mailing Address - Country:US
Mailing Address - Phone:276-207-0645
Mailing Address - Fax:
Practice Address - Street 1:17507 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-7835
Practice Address - Country:US
Practice Address - Phone:276-525-6043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst