Provider Demographics
NPI:1184981649
Name:PEACOCK, CARA K (LCSW)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:K
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38483-5068
Mailing Address - Country:US
Mailing Address - Phone:931-629-5490
Mailing Address - Fax:
Practice Address - Street 1:5226 MAIN ST
Practice Address - Street 2:STE. 100B
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-7403
Practice Address - Country:US
Practice Address - Phone:931-629-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000047341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527894Medicaid