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NPI Code Detail

MEDICARE: NICHOLA PEACOCK

MEDICARE: NICHOLA PEACOCK
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1255450367
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLA PEACOCK
Provider Business Mailing Address
First Line : 2775 E MILLBRAE AVE
Second Line :
City : FRESNO
State : CA
Zip : 93710-4822
Country : US
Telephone Number : 559-313-1707
Fax Number :
Provider Business Practice Location Address
First Line : 611 E BELMONT AVE
Second Line :
City : FRESNO
State : CA
Zip : 93701-1502
Country : US
Telephone Number : 559-237-3420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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Directions to “ NICHOLA PEACOCK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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