Individual
BRANDY MICHELLE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
135 W. MAIN STEET, CENTRALIA, WA 98531
(360) 748-4339
Mailing address
135 W. MAIN ST, CENTRALIA, WA 98531
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6064270
WA
Other
Enumeration date
03/13/2017
Last updated
03/13/2017
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