Provider Demographics
NPI:1538483136
Name:PETERSON-WILLIAMS, JUDITH R (LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:R
Last Name:PETERSON-WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 DERBY CIR
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-8512
Mailing Address - Country:US
Mailing Address - Phone:269-876-9986
Mailing Address - Fax:
Practice Address - Street 1:4808 DERBY CIR
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-8512
Practice Address - Country:US
Practice Address - Phone:269-876-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health