Provider Demographics
NPI:1689038309
Name:PEAKS VIEW COUNSELING, PLLC
Entity Type:Organization
Organization Name:PEAKS VIEW COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CEAP
Authorized Official - Phone:434-851-4855
Mailing Address - Street 1:1362 JEFFERSON WAY
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-4579
Mailing Address - Country:US
Mailing Address - Phone:434-851-4855
Mailing Address - Fax:434-608-0510
Practice Address - Street 1:800 BLUE RIDGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2429
Practice Address - Country:US
Practice Address - Phone:540-587-5852
Practice Address - Fax:540-586-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841556222Medicaid