Individual
MICHAEL TERRILL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2020 PEACH ORCHARD DR APT 31, FALLS CHURCH, VA 22043-2048
(217) 621-1331
Mailing address
2020 PEACH ORCHARD DR APT 31, FALLS CHURCH, VA 22043-2048
(217) 621-1331
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
1490164
IL
Other
Enumeration date
09/05/2012
Last updated
04/17/2023
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