Individual
LAVON L PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
95-1507 AINAMAKUA DR APT 30, MILILANI, HI 96789-4406
(808) 829-1717
Mailing address
95-1507 AINAMAKUA DR APT 30, MILILANI, HI 96789-4406
(808) 829-1717
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4815
HI
1041C0700X
Clinical Social Worker
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Other
Enumeration date
04/14/2022
Last updated
08/27/2024
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