Provider Demographics
NPI:1629609284
Name:PEACE, LA ROY'A ROCHELL
Entity Type:Individual
Prefix:MRS
First Name:LA ROY'A
Middle Name:ROCHELL
Last Name:PEACE
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 1:1031 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-4256
Mailing Address - Country:US
Mailing Address - Phone:209-940-5600
Mailing Address - Fax:
Practice Address - Street 1:1031 WATERLOO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-4256
Practice Address - Country:US
Practice Address - Phone:209-940-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA934571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical