Provider Demographics
NPI:1184342073
Name:HAUN, PEGGY A (MA, NCC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:HAUN
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 PALMER CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-4100
Mailing Address - Country:US
Mailing Address - Phone:251-404-4884
Mailing Address - Fax:
Practice Address - Street 1:17932 FRALEY BLVD STE 240
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2456
Practice Address - Country:US
Practice Address - Phone:571-636-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014936101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health