Provider Demographics
NPI:1407117807
Name:PETERS, SARAH LAUREL (MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LAUREL
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 TARA CT
Mailing Address - Street 2:71
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-8020
Mailing Address - Country:US
Mailing Address - Phone:925-984-4268
Mailing Address - Fax:
Practice Address - Street 1:1037 PATHFINDER WAY
Practice Address - Street 2:130
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3242
Practice Address - Country:US
Practice Address - Phone:321-639-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor