Provider Demographics
NPI:1164114187
Name:PEACOCK, ALEXIS J
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:J
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 462
Mailing Address - Street 2:
Mailing Address - City:ENKA
Mailing Address - State:NC
Mailing Address - Zip Code:28728-0462
Mailing Address - Country:US
Mailing Address - Phone:828-585-4950
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 462
Practice Address - Street 2:
Practice Address - City:ENKA
Practice Address - State:NC
Practice Address - Zip Code:28728-0462
Practice Address - Country:US
Practice Address - Phone:828-585-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17735101Y00000X, 101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health