Organization
J. PETERSON, PH.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOANNE PETERSON PH.D. (PSYCHOLOGIST)
(304) 876-3766
Entity
Organization
Contact information
Practice address
129 EAST GERMAN ST., SUITE 210, SHEPHERDSTOWN, WV 25443-1650
(304) 876-3766
(304) 876-8431
Mailing address
PO BOX 1650, SHEPHERDSTOWN, WV 25443-1650
(304) 876-3766
(304) 876-8631
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
07/02/2007
Last updated
08/22/2020
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