Provider Demographics
NPI:1346700580
Name:PETERS, KRISTINE A (CADC-I)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:A
Last Name:PETERS
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 CYPRESS PARK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2754
Mailing Address - Country:US
Mailing Address - Phone:702-682-6635
Mailing Address - Fax:
Practice Address - Street 1:3551 E BONANZA RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2198
Practice Address - Country:US
Practice Address - Phone:702-682-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV02358-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)