Provider Demographics
NPI:1679616627
Name:PEECHATKA, DAWN L (CACD,CRC,SAP,LPC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:L
Last Name:PEECHATKA
Suffix:
Gender:F
Credentials:CACD,CRC,SAP,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-0444
Mailing Address - Country:US
Mailing Address - Phone:570-426-5191
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 611
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372
Practice Address - Country:US
Practice Address - Phone:570-426-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002753101YA0400X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered251S00000XAgenciesCommunity/Behavioral Health