Provider Demographics
NPI:1346278280
Name:PETERSON, LAWRENCE G (MSW, LCSW, MPH)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:G
Last Name:PETERSON
Suffix:
Gender:M
Credentials:MSW, LCSW, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DENSBURY CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9791
Mailing Address - Country:US
Mailing Address - Phone:919-544-7682
Mailing Address - Fax:919-416-5834
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-6974
Practice Address - Fax:919-416-5834
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0017781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical