Healthcare Provider Details

I. General information

NPI: 1679486955
Provider Name (Legal Business Name): LEAH M PECK LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SOUTHLAND DR
FAIRMONT WV
26554-0129
US

IV. Provider business mailing address

PO BOX 164
GYPSY WV
26361-0164
US

V. Phone/Fax

Practice location:
  • Phone: 304-704-3885
  • Fax:
Mailing address:
  • Phone: 304-594-8447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00947362
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: