Provider Demographics
NPI:1790744845
Name:PEACE, STUART M III (MED, LPC, NCC, MAC)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:M
Last Name:PEACE
Suffix:III
Gender:M
Credentials:MED, LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 BRIGHAM TRL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6061
Mailing Address - Country:US
Mailing Address - Phone:706-469-7970
Mailing Address - Fax:
Practice Address - Street 1:EISENHOWER ARMY MEDICAL CENTER, BLDG 300
Practice Address - Street 2:13TH FLOOR, OUTPATIENT BEHAVIORAL HEALTH SERVICES
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-469-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE105101Y00000X
NE135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor