Individual
DESTINY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
25900 GREENFIELD RD STE 100, OAK PARK, MI 48237-1297
(248) 788-4300
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 486-6790
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301016731
MI
Other
Enumeration date
12/05/2016
Last updated
07/21/2022
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