Provider Demographics
NPI:1881675668
Name:PEACOCK, MARY C (MSW, LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MSW, LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HERITAGE OAK LN
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4281
Mailing Address - Country:US
Mailing Address - Phone:269-979-4800
Mailing Address - Fax:
Practice Address - Street 1:9 HERITAGE OAK LN
Practice Address - Street 2:SUITE 9
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4281
Practice Address - Country:US
Practice Address - Phone:269-979-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010148791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0892716Medicare PIN