Provider Demographics
NPI:1558681916
Name:PEEK, MANDI (LPC)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:PEEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 OLD ALABAMA RD STE 625
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2264
Mailing Address - Country:US
Mailing Address - Phone:404-917-9917
Mailing Address - Fax:770-289-1203
Practice Address - Street 1:1875 OLD ALABAMA RD STE 625
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2264
Practice Address - Country:US
Practice Address - Phone:678-757-5785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional