Provider Demographics
NPI:1508036013
Name:PEATY, ROBERT A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:PEATY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5325
Mailing Address - Country:US
Mailing Address - Phone:336-722-8173
Mailing Address - Fax:336-724-6491
Practice Address - Street 1:610 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5325
Practice Address - Country:US
Practice Address - Phone:336-722-8173
Practice Address - Fax:336-724-6491
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1217106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist