Provider Demographics
NPI:1467007195
Name:PETERS, ELEANOR (CADC - CAS)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:CADC - CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13972 CERISE AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8118
Mailing Address - Country:US
Mailing Address - Phone:310-562-2905
Mailing Address - Fax:
Practice Address - Street 1:11227 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3225
Practice Address - Country:US
Practice Address - Phone:626-444-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC058980718101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)