Basic Information
| Provider Information | |||||||||
| NPI: | 1992746549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCPEAK | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | GRIFFIN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW, LCAS, CCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 GREENHILL RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270302320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367836919 | ||||||||
| FaxNumber: | 3367836923 | ||||||||
| Practice Location | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C004787 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 6003125 | 05 | NC | MEDICAID |