Individual
SAMUEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4600 DEBARR RD, ANCHORAGE, AK 99508-3103
(908) 885-1089
Mailing address
13100 BISCAYNE CIR, ANCHORAGE, AK 99516-2740
(907) 223-5909
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
154793
AK
101YP2500X
Professional Counselor
Primary
154793
AK
Other
Enumeration date
01/25/2020
Last updated
01/25/2020
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