Individual
BERONICA PAULINE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
296 MERCHANTS SQ, DALLAS, GA 30132-5029
(470) 391-2300
Mailing address
300 INTERNATIONAL PKWY STE 200, LAKE MARY, FL 32746-5028
(866) 610-0580
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/26/2024
Last updated
04/26/2024
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