Individual
ANN MARIE PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW,CADC
Contact information
Practice address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1881
Mailing address
1200 W STATE ST, ROCKFORD, IL 61102-2112
(815) 490-1600
(815) 490-1881
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
18135
IL
1041C0700X
Clinical Social Worker
Primary
149009048
IL
Other
Enumeration date
07/31/2014
Last updated
03/10/2020
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