Provider Demographics
NPI:1033111398
Name:STERRETT, PETER (LCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:STERRETT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SENOMA PL
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8982
Mailing Address - Country:US
Mailing Address - Phone:919-303-3425
Mailing Address - Fax:919-226-0026
Practice Address - Street 1:433 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3217
Practice Address - Country:US
Practice Address - Phone:919-433-0170
Practice Address - Fax:919-226-0026
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024961041C0700X
NCC0055051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008912793Medicaid
VA776769000OtherMAGELLAN HEALTH SERVICES
VA9374511OtherPHCS
VA008912793Medicaid