Provider Demographics
NPI:1073207726
Name:PETERS, WILLIAM DUSTIN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DUSTIN
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MINGA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-4131
Mailing Address - Country:US
Mailing Address - Phone:423-742-0080
Mailing Address - Fax:
Practice Address - Street 1:501 N CHEROKEE ST STE 2
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5599
Practice Address - Country:US
Practice Address - Phone:423-742-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist