Provider Demographics
NPI:1710468657
Name:PEACOCK, ELEANOR GARRETT (MS)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:GARRETT
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 E MONROE AVE APT 402
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-3029
Mailing Address - Country:US
Mailing Address - Phone:703-615-7574
Mailing Address - Fax:
Practice Address - Street 1:8613 LEE HWY # 200N
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2171
Practice Address - Country:US
Practice Address - Phone:703-208-3155
Practice Address - Fax:703-280-9596
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPGC130170300000X
VA0139000425170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS