Individual
J. PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., L.L.C.
Contact information
Practice address
129 EAST GERMAN STREET, ROOM 210, SHEPHERDSTOWN, WV 25443-1650
(304) 876-3766
(304) 876-8431
Mailing address
PO BOX 1650, SHEPHERDSTOWN, WV 25443-1650
(304) 876-3766
(304) 876-8431
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
741
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9480075000
—
WV
Enumeration date
12/29/2006
Last updated
02/27/2008
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