Provider Demographics
NPI:1780806380
Name:VENABLE, PETER CARRINGTON (LPC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CARRINGTON
Last Name:VENABLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 QUEENSWQOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-4953
Mailing Address - Country:US
Mailing Address - Phone:336-760-0797
Mailing Address - Fax:336-760-0797
Practice Address - Street 1:284 EXECUTIVE PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1833
Practice Address - Country:US
Practice Address - Phone:704-939-1184
Practice Address - Fax:704-939-1173
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC143101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)