Provider Demographics
NPI:1972927986
Name:PEAKE, THOMAS R II (MS/EDS)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:PEAKE
Suffix:II
Gender:M
Credentials:MS/EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17304
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27116-7304
Mailing Address - Country:US
Mailing Address - Phone:336-408-7051
Mailing Address - Fax:
Practice Address - Street 1:8025 N POINT BLVD
Practice Address - Street 2:SUITE 284
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3262
Practice Address - Country:US
Practice Address - Phone:336-408-7051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10310101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional