Individual
MICHELLE DANIELLE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
27 HIAWATHA CT, MIDLAND PARK, NJ 07432-1005
(856) 373-8639
Mailing address
27 HIAWATHA CT, MIDLAND PARK, NJ 07432-1005
(856) 373-8639
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37PC005551000
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00247400
NJ
Other
Enumeration date
07/11/2016
Last updated
07/28/2016
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