Provider Demographics
NPI:1467163667
Name:THE PEABODY PRACTICE, LLC
Entity Type:Organization
Organization Name:THE PEABODY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAYE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PEABODY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CPC
Authorized Official - Phone:470-774-1529
Mailing Address - Street 1:3142 KITTERY DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6026
Mailing Address - Country:US
Mailing Address - Phone:678-995-1717
Mailing Address - Fax:
Practice Address - Street 1:3142 KITTERY DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6026
Practice Address - Country:US
Practice Address - Phone:678-995-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty