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Individual

MR. KEVIN LEON PETERSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSY.D.

Contact information

Practice address
6439 GARNERS FERRY ROAD, WJBD VA MEDICAL CENTER, COLUMBIA, SC 29209
(803) 776-4000
Mailing address
115 RED COAT LN, COLUMBIA, SC 29223-2827
(602) 790-5900

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary

Other

Enumeration date
10/09/2009
Last updated
10/09/2009
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