Individual
JOHN PETERSON
Active
Individual
JOHN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISW, CDCA
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
0012311
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
011229
OH
1041C0700X
Clinical Social Worker
Primary
I1801316
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2901131
—
OH
Enumeration date
05/12/2016
Last updated
11/30/2018
Update your record
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