Provider Demographics
NPI:1780339366
Name:ABIGAIL PECK, PLLC
Entity type:Organization
Organization Name:ABIGAIL PECK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-C
Authorized Official - Phone:231-442-0887
Mailing Address - Street 1:3301 VETERANS DR STE 106
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4592
Mailing Address - Country:US
Mailing Address - Phone:231-442-0887
Mailing Address - Fax:231-220-9820
Practice Address - Street 1:3301 VETERANS DR STE 106
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4592
Practice Address - Country:US
Practice Address - Phone:231-442-0887
Practice Address - Fax:231-220-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-13
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)