Provider Demographics
NPI:1225307606
Name:PEYTON, DEDRICK D (LMHC)
Entity type:Individual
Prefix:MR
First Name:DEDRICK
Middle Name:D
Last Name:PEYTON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2954
Mailing Address - Country:US
Mailing Address - Phone:407-704-0370
Mailing Address - Fax:877-546-7604
Practice Address - Street 1:165 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2954
Practice Address - Country:US
Practice Address - Phone:407-704-0370
Practice Address - Fax:877-546-7604
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1073360-00Medicaid