Provider Demographics
NPI:1144382128
Name:PETERSEN, LOIS ROSELYN (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ROSELYN
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 BEN CLARK RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-7165
Mailing Address - Country:US
Mailing Address - Phone:828-380-1681
Mailing Address - Fax:828-680-9736
Practice Address - Street 1:281 BEN CLARK RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:NC
Practice Address - Zip Code:28753-7165
Practice Address - Country:US
Practice Address - Phone:828-380-1681
Practice Address - Fax:828-680-9736
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5435OtherLPC
NC6103506Medicaid