Healthcare Provider Details

I. General information

NPI: 1184470403
Provider Name (Legal Business Name): PEGGY WALLACE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W WILLIAMS ST STE 231G
APEX NC
27502-5204
US

IV. Provider business mailing address

800 W WILLIAMS ST STE 231G
APEX NC
27502-5204
US

V. Phone/Fax

Practice location:
  • Phone: 919-720-8820
  • Fax: 252-513-7027
Mailing address:
  • Phone: 919-720-8820
  • Fax: 252-513-7027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PEGGY WALLACE
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: MSW, LCSW
Phone: 919-720-8820