Individual
JACITA BOOKER PETWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1000 N 1ST ST STE 1, ALBEMARLE, NC 28001-2819
(704) 938-2117
(704) 938-2636
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LPA# 3738
NC
Other
Enumeration date
04/08/2009
Last updated
07/21/2022
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