Provider Demographics
NPI:1659041507
Name:PETERSON, SABRINA JEANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:JEANNE
Last Name:PETERSON
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 1:9301 PARK WEST BLVD STE B5
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4300
Mailing Address - Country:US
Mailing Address - Phone:512-636-9560
Mailing Address - Fax:
Practice Address - Street 1:9301 PARK WEST BLVD STE B5
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4300
Practice Address - Country:US
Practice Address - Phone:512-636-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80922101YM0800X, 101YP2500X
TN5652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80922OtherTEXAS BOARD OF PROFESSIONAL COUNSELORS