Individual
JORDAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3305 HEALY DR, WINSTON SALEM, NC 27103-1406
(336) 448-4451
Mailing address
3305 HEALY DR, WINSTON SALEM, NC 27103-1406
(336) 448-4451
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A19428
NC
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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