Provider Demographics
NPI:1811181050
Name:PEATY, LISA ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANNE
Last Name:PEATY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:SINKSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:610 COLISEUM DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5325
Mailing Address - Country:US
Mailing Address - Phone:336-722-8173
Mailing Address - Fax:336-724-6491
Practice Address - Street 1:610 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5325
Practice Address - Country:US
Practice Address - Phone:336-722-8173
Practice Address - Fax:336-724-6491
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0049331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical