Provider Demographics
NPI:1730631797
Name:IGWACHO, PETER (PHD,CDCS, MAC, LSATP)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:IGWACHO
Suffix:
Gender:M
Credentials:PHD,CDCS, MAC, LSATP
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:NJI
Other - Last Name:IGWACHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3924 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2637
Mailing Address - Country:US
Mailing Address - Phone:907-350-2326
Mailing Address - Fax:
Practice Address - Street 1:3924 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2637
Practice Address - Country:US
Practice Address - Phone:907-350-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA508611101YA0400X
VA21043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)