Provider Demographics
NPI:1366629990
Name:PEERSON, CHARLES THOMAS II
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:THOMAS
Last Name:PEERSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 PARRIZA CT
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4544
Mailing Address - Country:US
Mailing Address - Phone:805-400-8509
Mailing Address - Fax:
Practice Address - Street 1:7257 PARRIZA CT
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4544
Practice Address - Country:US
Practice Address - Phone:805-400-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor