Individual
DR. PETER JOHN THAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
510 PRINCESS ANNE ST STE 102, FREDERICKSBURG, VA 22401-6077
(540) 698-0003
Mailing address
8931 QUARRY RD, MANASSAS, VA 20110-5160
(703) 969-4539
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
0810006004
VA
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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