Individual
MICHAEL STEPHEN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2425 BISSO LN STE 100, CONCORD, CA 94520-4817
(925) 500-3093
Mailing address
PO BOX 21352, CONCORD, CA 94521-0352
(925) 826-9640
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
CA
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
MPSS-DWMIVN
CA
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
10/28/2021
Last updated
05/01/2025
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