Basic Information
| Provider Information | |||||||||
| NPI: | 1427786466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEACE | ||||||||
| FirstName: | ELVIN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LCMHCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 WINDY TRL | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285602748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282468401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1309 TATUM DR | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285604314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526728742 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2022 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A17694 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.