Provider Demographics
NPI:1659900793
Name:PEATY COUNSELING AND CONSULTING, PLLC
Entity Type:Organization
Organization Name:PEATY COUNSELING AND CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEATY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:919-622-7213
Mailing Address - Street 1:138 S CHERRY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5271
Mailing Address - Country:US
Mailing Address - Phone:336-281-5331
Mailing Address - Fax:
Practice Address - Street 1:1250 FOXHALL DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4436
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty