Provider Demographics
NPI:1518456011
Name:PETERS, SENSEMILLAH ZAKIYA (CLINSCD CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:SENSEMILLAH
Middle Name:ZAKIYA
Last Name:PETERS
Suffix:
Gender:F
Credentials:CLINSCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 FREEMAN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001
Mailing Address - Country:US
Mailing Address - Phone:347-757-7832
Mailing Address - Fax:
Practice Address - Street 1:11201 LIVINGSTON MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273
Practice Address - Country:US
Practice Address - Phone:704-654-8599
Practice Address - Fax:980-938-6088
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6269235Z00000X
NC1812291235Z00000X
NC13141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13141OtherNCBOSLPA LICENSE
NC1812291OtherNC LICENSE