Provider Demographics
NPI:1902532872
Name:CLINTON, PEGGY (LCPC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22663 KINNEGAD DR
Mailing Address - Street 2:
Mailing Address - City:GREAT MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20634-3481
Mailing Address - Country:US
Mailing Address - Phone:240-561-1960
Mailing Address - Fax:
Practice Address - Street 1:22663 KINNEGAD DR
Practice Address - Street 2:
Practice Address - City:GREAT MILLS
Practice Address - State:MD
Practice Address - Zip Code:20634-3481
Practice Address - Country:US
Practice Address - Phone:240-561-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17186101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral