Provider Demographics
NPI:1962953240
Name:PECK, LYDIA SPENCER (MS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:SPENCER
Last Name:PECK
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:WALNUT COVE
Mailing Address - State:NC
Mailing Address - Zip Code:27052-6813
Mailing Address - Country:US
Mailing Address - Phone:336-501-0509
Mailing Address - Fax:
Practice Address - Street 1:1230 MORGAN ST
Practice Address - Street 2:
Practice Address - City:WALNUT COVE
Practice Address - State:NC
Practice Address - Zip Code:27052-6813
Practice Address - Country:US
Practice Address - Phone:336-501-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
NC1-21-48030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician