Provider Demographics
NPI:1598778714
Name:PEELE, GLADUES WILDRED JR (LPC, LCAS)
Entity Type:Individual
Prefix:MR
First Name:GLADUES
Middle Name:WILDRED
Last Name:PEELE
Suffix:JR
Gender:M
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4801
Mailing Address - Country:US
Mailing Address - Phone:252-975-3111
Mailing Address - Fax:252-975-3035
Practice Address - Street 1:323 W 2ND ST
Practice Address - Street 2:PASSAGES COUNSELING SERVICES
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4801
Practice Address - Country:US
Practice Address - Phone:252-975-3111
Practice Address - Fax:252-975-3035
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3705101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
13690OtherBCBS NC PIN