Organization
CHRISTINE R PETRO, PSY.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE RENEE PETRO PSY.D. (PSY.D.)
(770) 785-2545
Entity
Organization
Contact information
Practice address
69 GRAYSON NEW HOPE RD, GRAYSON, GA 30017
(770) 785-2545
Mailing address
69 GRAYSON NEW HOPE RD, GRAYSON, GA 30017-1363
(770) 785-2545
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
PSY003011
GA
103TC0700X
Clinical Psychologist
PSY003011
GA
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY003011
GA
103TF0000X
Family Psychologist
PSY003011
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
668652382C
—
GA
05
—
668652382E
—
GA
Enumeration date
09/15/2009
Last updated
06/08/2018
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