Provider Demographics
NPI:1285654392
Name:PEACH, GAIL H (LCMHC RNC)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:H
Last Name:PEACH
Suffix:
Gender:F
Credentials:LCMHC RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MAIN ST
Mailing Address - Street 2:SUITE 614
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3040
Mailing Address - Country:US
Mailing Address - Phone:802-254-9946
Mailing Address - Fax:
Practice Address - Street 1:139 MAIN ST
Practice Address - Street 2:SUITE 614
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3040
Practice Address - Country:US
Practice Address - Phone:802-254-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000549101YM0800X
NH27101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT29904OtherBCBS
NH30422971Medicaid
VT698771OtherMVP
VT1009635Medicaid
VT1051619OtherCIGNA