Individual
KIRIN TECHAWONGTHAM PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
1206 YORK RD STE 202, LUTHERVILLE, MD 21093-6217
(443) 718-0496
Mailing address
3105 WHITE AVE, BALTIMORE, MD 21214-2227
(501) 505-6362
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LGP14188
MD
101YM0800X
Mental Health Counselor
Primary
LGP14188
MD
101YP2500X
Professional Counselor
LGP14188
MD
Other
Enumeration date
08/09/2023
Last updated
08/31/2023
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