Individual
THERESA ELIZABETH PETROSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
35 MILES ST, DAMARISCOTTA, ME 04543-4047
(207) 563-1234
Mailing address
11036 FOLKSTONE DR # OK, YUKON, OK 73099-8050
(405) 922-6695
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CC6723
ME
101YM0800X
Mental Health Counselor
10200
OK
Other
Enumeration date
07/30/2019
Last updated
08/24/2022
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