Individual
MICHELLE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1816 BULL ST, COLUMBIA, SC 29201-2506
(803) 422-0017
Mailing address
943 MONTAGUE RD, COLUMBIA, SC 29209-1015
(803) 629-8632
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1271
SC
Other
Enumeration date
07/12/2013
Last updated
07/12/2013
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