Individual
GARY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC 2
Contact information
Practice address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Mailing address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/22/2016
Last updated
01/22/2016
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