Individual
KASEY GRAHAM PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
89 OLD TROLLEY RD # B, 202, SUMMERVILLE, SC 29485-4951
(843) 875-0017
(843) 486-8394
Mailing address
401 MATHER GREEN AVE APT C, CHARLOTTE, NC 28203-5676
(803) 524-9715
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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