Provider Information for 1972852978
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MICHAEL TERRILL PETERSON LCSW
Sex: Male
NPI: 1972852978
Last Updated: 2023-04-17
Certification Date: 2023-04-17
Certification Date: 2023-04-17
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1972852978 | ||||||||||||
| Enumeration Date | 2012-09-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2020 PEACH ORCHARD DR APT 31 FALLS CHURCH, VA 22043-2048 United States Phone: 217-621-1331 | Fax: | ||||||||||||
| Primary Practice Address | 2020 PEACH ORCHARD DR APT 31 FALLS CHURCH, VA 22043-2048 United States Phone: 217-621-1331 | Fax: | ||||||||||||
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