MEDICARE: AMELIA LOUISE PEEBLES

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	101YM0800X	Mental Health Counselor	5053	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141X8	OTHER	NC	BCBS
2	743170946	OTHER	NC	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1699014076	OTHER	NC	COMMUNITY LINK COUNSELING SERVICES

General Provider Information

NPI Number	:	1487625497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA LOUISE PEEBLES

Provider Business Mailing Address
First Line	:	3751 JUNCTION BLVD STE D
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-5263
Country	:	US
Telephone Number	:	919-264-5332
Fax Number	:

Provider Business Practice Location Address
First Line	:	3751 JUNCTION BLVD STE D
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-5263
Country	:	US
Telephone Number	:	919-264-5332
Fax Number	:

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	10/20/2022

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Directions to “ AMELIA LOUISE PEEBLES ” Practice Location

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