Wallace T. Peake Jr., MSW, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P016244 Issued in NC

Practice address

1935 J N Pease PL Ste 104
Charlotte, NC 28262-4541

Phone

(980) 288-5486

NPI assigned

Jun 2, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1467028159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4614 WILGROVE MINT HILL RD # 1",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282273500",
            "telephone_number": "980-231-1937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 J N PEASE PL STE 104",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282624541",
            "telephone_number": "980-288-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEAKE",
        "first_name": "WALLACE",
        "middle_name": "T.",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MSW, LCSWA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-02",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P016244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Leigh Peacock, LCSW
• Peak Family Health PLLC
• Peak Homecare Agency LLC
• Peak Performance Agency LLC
• Peak Potential Psychology, PLLC
• Peam Home Healthcare Agency LLC
• Daniel Barham Pearce, HIS
• Lauren Pearce, DPT
• Makenzie P Pearce, HAS
• Mary Pearce

• Clinical Social Worker in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.