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General NPI Number Information
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NPI Number | 1952554206
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Entity Type | Individual
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Provider Name | PEGGY S DIAZ DE LEON LPC, MAC, NCC,CACIII
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Gender | Female
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 6541 SPECKER AVE BLDG 1830
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City | FORT CARSON
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State | CO
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Zip | 80913-4263
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Country | US
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Telephone | 719-524-0904
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Fax |
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Provider Business Mailing Address
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Address Line | EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE
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City | FT CARSON
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State | CO
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Zip | 80913
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Country | US
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Telephone | 719-524-0904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ACC0007204
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License Number State | CO
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