Provider Demographics
NPI:1013170844
Name:PEGGI S WEGENER EDS INC
Entity type:Organization
Organization Name:PEGGI S WEGENER EDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGI
Authorized Official - Middle Name:SANBORN
Authorized Official - Last Name:WEGENER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, BCPCC
Authorized Official - Phone:904-262-1900
Mailing Address - Street 1:2950 HALCYON LN STE 204
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6690
Mailing Address - Country:US
Mailing Address - Phone:904-262-1900
Mailing Address - Fax:904-262-1905
Practice Address - Street 1:2950 HALCYON LN STE 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6690
Practice Address - Country:US
Practice Address - Phone:904-262-1900
Practice Address - Fax:904-262-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0003102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty