Individual
KENYUN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 2ND LOOP RD STE 444, FLORENCE, SC 29505-2817
(803) 905-5107
Mailing address
2580 LIN DO CT, SUMTER, SC 29150-1832
(803) 905-4427
(803) 905-4431
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
17-37391
SC
Other
Enumeration date
04/20/2018
Last updated
04/20/2018
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