Individual
LARRY DEAN PEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, CSAC
Contact information
Practice address
4213 WALNEY RD, CHANTILLY, VA 20151-2923
(703) 502-7039
(703) 502-7055
Mailing address
6614 CUSTER ST, SPRINGFIELD, VA 22150-1501
(703) 922-6544
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003461
VA
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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