Provider Demographics
NPI:1629716949
Name:PECK, RICHARD GERRY JR (LACMH, NCC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GERRY
Last Name:PECK
Suffix:JR
Gender:M
Credentials:LACMH, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HAWTHORNE CT W
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-1800
Mailing Address - Country:US
Mailing Address - Phone:302-530-7434
Mailing Address - Fax:
Practice Address - Street 1:8 POLLY DRUMMOND HILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5703
Practice Address - Country:US
Practice Address - Phone:302-738-6859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAC-0010349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health