MEDICARE: MANDI PEEK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC004118	GA

General Provider Information

NPI Number	:	1558681916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDI PEEK LPC

Provider Business Mailing Address
First Line	:	1875 OLD ALABAMA RD STE 625
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-2264
Country	:	US
Telephone Number	:	404-917-9917
Fax Number	:	770-289-1203

Provider Business Practice Location Address
First Line	:	1875 OLD ALABAMA RD STE 625
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-2264
Country	:	US
Telephone Number	:	678-757-5785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	01/23/2017

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Directions to “ MANDI PEEK LPC” Practice Location

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