Individual
ALISA MICHELLE PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
5901 N LIDGERWOOD ST STE 115, SPOKANE, WA 99208-1122
(509) 838-4651
(509) 363-2762
Mailing address
107 S DIVISION ST, SPOKANE, WA 99202-1510
(509) 838-4651
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG60968873
WA
390200000X
Student in an Organized Health Care Education/Training Program
CG60968873
WA
Other
Enumeration date
05/29/2019
Last updated
04/05/2021
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