Provider Demographics
NPI:1568529170
Name:KATHRYN PETTERSON LLC
Entity Type:Organization
Organization Name:KATHRYN PETTERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-606-3247
Mailing Address - Street 1:295 S CULVER ST STE D
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3239
Mailing Address - Country:US
Mailing Address - Phone:770-995-5555
Mailing Address - Fax:770-497-0130
Practice Address - Street 1:295 S CULVER ST STE D
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3239
Practice Address - Country:US
Practice Address - Phone:770-995-5555
Practice Address - Fax:770-497-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC2113101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty