Provider Demographics
NPI:1518686815
Name:PETERS, EVELYN D (LMSW)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:D
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMSW
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 316
Mailing Address - Street 2:
Mailing Address - City:LORMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39096-0316
Mailing Address - Country:US
Mailing Address - Phone:601-384-7315
Mailing Address - Fax:
Practice Address - Street 1:701 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3313
Practice Address - Country:US
Practice Address - Phone:601-597-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker