Provider Demographics
NPI:1023553443
Name:MCCORMICK, PEGGY
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6775 POINT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25262-8100
Mailing Address - Country:US
Mailing Address - Phone:304-273-0112
Mailing Address - Fax:304-273-0115
Practice Address - Street 1:6775 POINT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:WV
Practice Address - Zip Code:25262-8100
Practice Address - Country:US
Practice Address - Phone:304-273-0112
Practice Address - Fax:304-273-0115
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00944379104100000X
OH1600061104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAP00944379OtherBOARD OF SOCIAL WORK
OH1600061OtherCOUNSELOR SOCIAL WORKER MARRIAGE & FAMILY THERAPIST BOARD