Individual
ANGELA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2211 FULTON AVE, CINCINNATI, OH 45206-2504
(513) 961-4663
Mailing address
7804 NEWBEDFORD AVE, CINCINNATI, OH 45237-1010
(513) 652-7833
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.161374
OH
104100000X
Social Worker
S.2309688
OH
Other
Enumeration date
08/21/2017
Last updated
12/20/2023
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