Provider Demographics
NPI:1033135827
Name:PETERS, CLAY E II (EDD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:E
Last Name:PETERS
Suffix:II
Gender:M
Credentials:EDD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-3017
Mailing Address - Country:US
Mailing Address - Phone:540-314-1640
Mailing Address - Fax:
Practice Address - Street 1:1125 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3017
Practice Address - Country:US
Practice Address - Phone:540-314-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701003318OtherSTATE LPC LICENSE