Provider Demographics
NPI:1538327382
Name:PETERSON-ROCHON, GIAWANNA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GIAWANNA
Middle Name:
Last Name:PETERSON-ROCHON
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 1:26520 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1506
Mailing Address - Country:US
Mailing Address - Phone:313-533-5652
Mailing Address - Fax:313-533-5644
Practice Address - Street 1:26520 GRAND RIVER AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1506
Practice Address - Country:US
Practice Address - Phone:313-533-5652
Practice Address - Fax:313-533-5644
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0896890OtherBCBS
MIOP03580Medicare PIN
MIMI 1211Medicare PIN