Individual
GREGORY PETERSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2017 JEFFERSON ST SW, ROANOKE, VA 24014-2419
(540) 981-7097
Mailing address
411 WASHINGTON AVE SW, ROANOKE, VA 24016-4217
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810-002774
VA
Other
Enumeration date
02/24/2006
Last updated
07/08/2007
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