Provider Demographics
NPI:1598195901
Name:PEEBLES, TIESHA
Entity Type:Individual
Prefix:
First Name:TIESHA
Middle Name:
Last Name:PEEBLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIESHA
Other - Middle Name:NICOLE
Other - Last Name:PEEBLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPCA
Mailing Address - Street 1:110 RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2227
Mailing Address - Country:US
Mailing Address - Phone:919-285-4963
Mailing Address - Fax:
Practice Address - Street 1:110 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2227
Practice Address - Country:US
Practice Address - Phone:919-285-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional