Active NPI
Gretchen H Peacock, DMFT
- Professional Counselor
- Fayetteville, GA
National Provider Identifier
1407924343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC001611
- Practice address
- 115 Habersham Dr
Fayetteville, GA 30214 - Phone
- (770) 461-9944
- Fax
- (770) 461-9779
- NPI assigned
- Nov 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC001611 | GA | Primary |
Addresses
Primary practice location
115 Habersham Dr
Fayetteville, GA 30214
Mailing address
115 Habersham Dr
Fayetteville, GA 30214
Phone (770) 461-9944
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC001611 | GA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A New Start Counseling Center Inc | Professional | Past | Accepting new patients |
| Accordia Counseling Solutions | Professional | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407924343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 HABERSHAM DR",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "30214",
"telephone_number": "770-461-9944",
"fax_number": "770-461-9779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 HABERSHAM DR",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "30214",
"telephone_number": "770-461-9944",
"fax_number": "770-461-9779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEACOCK",
"first_name": "GRETCHEN",
"middle_name": "H",
"credential": "DMFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC001611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.