Provider Demographics
NPI:1346397627
Name:PETTERS, DOROTHY BOLING (LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:BOLING
Last Name:PETTERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:DIANE
Other - Last Name:PETTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3525 PIEDMONT RD.
Mailing Address - Street 2:BLDG. 8, SUITE 102
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-351-0199
Mailing Address - Fax:404-848-9974
Practice Address - Street 1:3525 PIEDMONT ROAD, NE
Practice Address - Street 2:BLDG. 8, SUITE 102
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1533
Practice Address - Country:US
Practice Address - Phone:404-351-0199
Practice Address - Fax:404-848-9974
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional