Individual
MR. ROBIN ROSS PEACOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAC
Contact information
Practice address
2127 LINCOLN AVE, OGDEN, UT 84401-1313
(801) 625-3686
(801) 621-4203
Mailing address
5961 W 5050 S, HOOPER, UT 84315-9720
(801) 985-9891
(801) 621-4203
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
138819-6006
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
876000308007
—
UT
Enumeration date
04/24/2007
Last updated
07/08/2007
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