Individual
MS. GEORGINA MARIE PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
661 W LAKE ST STE 2S, CHICAGO, IL 60661-1034
(312) 569-9422
Mailing address
616 W FULTON ST APT 603, CHICAGO, IL 60661-1269
(312) 569-9422
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
166001486
IL
106H00000X
Marriage & Family Therapist
208000744
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166001486
LMFT STATE LICENSE
IL
Enumeration date
02/09/2021
Last updated
09/06/2022
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