Provider Demographics
NPI:1326636143
Name:PETERS, AMINA NICOLE (LLMSW)
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:NICOLE
Last Name:PETERS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:AMINA
Other - Middle Name:NICOLE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3153 ROSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1852
Mailing Address - Country:US
Mailing Address - Phone:734-474-4729
Mailing Address - Fax:
Practice Address - Street 1:3153 ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1852
Practice Address - Country:US
Practice Address - Phone:734-474-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801108100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker