Provider Demographics
NPI:1245581925
Name:PETERS, DEBRA ANN (LMSW, LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 44TH ST SE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5323
Mailing Address - Country:US
Mailing Address - Phone:616-455-1499
Mailing Address - Fax:616-455-1499
Practice Address - Street 1:2180 44TH ST SE
Practice Address - Street 2:SUITE 108
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5323
Practice Address - Country:US
Practice Address - Phone:616-455-1499
Practice Address - Fax:616-455-1499
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006602101YP2500X
MI68010570191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional