Provider Demographics
NPI:1386828465
Name:PETOSA, CHERYL ANNE (MED,CMHS)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANNE
Last Name:PETOSA
Suffix:
Gender:F
Credentials:MED,CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0160
Mailing Address - Country:US
Mailing Address - Phone:360-678-5555
Mailing Address - Fax:360-678-3636
Practice Address - Street 1:105 N.W. 1ST ST.
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-0160
Practice Address - Country:US
Practice Address - Phone:360-678-5555
Practice Address - Fax:360-678-3636
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60202326101Y00000X
WARC00028549101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor