Provider Demographics
NPI:1972537389
Name:WEAVER, PEGGY LYNN (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY LYNN
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 LIBERTY RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6420
Mailing Address - Country:US
Mailing Address - Phone:410-552-0773
Mailing Address - Fax:410-552-0774
Practice Address - Street 1:79 EAST MAIN STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-552-0773
Practice Address - Fax:410-552-0774
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02813101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health