Individual
MR. JAMES JERRY PETERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA.
Contact information
Practice address
2138 BLACKWOLF RUN LN, RALEIGH, NC 27604-5411
(916) 627-5859
Mailing address
2138 BLACKWOLF RUN LN, RALEIGH, NC 27604-5411
(916) 627-5859
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/16/2017
Last updated
09/18/2023
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