Organization
JSPETERSONYOUTHLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES JERRY PETERSON III BA (SPECIAL INSTRUCTION)
(916) 627-5859
Entity
Organization
Contact information
Practice address
2138 BLACKWOLF RUN LN, RALEIGH, NC 27604-5411
(916) 627-5859
Mailing address
2138 BLACKWOLF RUN LN, RALEIGH, NC 27604-5411
(916) 627-5859
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
09/08/2023
Last updated
09/08/2023
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