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Individual
MR. KEVIN LEE PETTUS
Active
Individual
MR. KEVIN LEE PETTUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCS, ACADC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12002
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13012
ID
Other
Enumeration date
07/05/2014
Last updated
09/03/2021
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