Provider Demographics
NPI:1487625497
Name:PEEBLES, AMELIA LOUISE
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:LOUISE
Last Name:PEEBLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 JUNCTION BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5263
Mailing Address - Country:US
Mailing Address - Phone:919-264-5332
Mailing Address - Fax:
Practice Address - Street 1:3751 JUNCTION BLVD STE D
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-5263
Practice Address - Country:US
Practice Address - Phone:919-264-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC141X8OtherBCBS
NC743170946OtherTRICARE
NC6102867Medicaid
NC1699014076OtherCOMMUNITY LINK COUNSELING SERVICES