Provider Demographics
NPI:1427310184
Name:PECK, JANE A (CNS)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:PECK
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BILLINGSLEY RD
Mailing Address - Street 2:BEHAVIORAL HEALTH CENTER CMC RANDOLPH
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1009
Mailing Address - Country:US
Mailing Address - Phone:704-358-2710
Mailing Address - Fax:704-358-2938
Practice Address - Street 1:501 BILLINGSLEY RD
Practice Address - Street 2:BEHAVIORAL HEALTH CENTER CMC RANDOLPH
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1009
Practice Address - Country:US
Practice Address - Phone:704-358-2700
Practice Address - Fax:704-444-2532
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC826101YA0400X
NC950005364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)