Individual
DAVID PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6200 S SYRACUSE WAY STE 260, GREENWOOD VILLAGE, CO 80111-4739
(719) 332-6767
Mailing address
415 N TEJON ST, COLORADO SPRINGS, CO 80903-1101
(719) 332-6767
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
81
CO
1041C0700X
Clinical Social Worker
Primary
255
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
099366
—
CO
Enumeration date
10/15/2006
Last updated
01/26/2023
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