Basic Information
| Provider Information | |||||||||
| NPI: | 1376292441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEEK | ||||||||
| FirstName: | MAIZEY | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | LCSWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 SHIPYARD BLVD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284126431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103430145 | ||||||||
| FaxNumber: | 9102029966 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 DOCTORS CIR STE 1 | ||||||||
| Address2: | |||||||||
| City: | SUPPLY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284626358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197544233 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2022 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | PO17239 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | PO17239 | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.