Provider Demographics
NPI:1871640615
Name:PEACOCK, NATALIE (MSW, LCSW, CGP)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MSW, LCSW, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 W CLUB BLVD
Mailing Address - Street 2:SUITE 6662
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-1104
Mailing Address - Country:US
Mailing Address - Phone:919-876-5256
Mailing Address - Fax:919-416-4404
Practice Address - Street 1:1058 W CLUB BLVD
Practice Address - Street 2:SUITE 6662
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-1104
Practice Address - Country:US
Practice Address - Phone:919-876-5256
Practice Address - Fax:919-416-4404
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0034771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7918264OtherAETNA HEALTHCARE
NC6002260Medicaid
NC12902OtherBCBSNC
NC6002260Medicaid