Provider Demographics
NPI:1689097123
Name:PETRIE, GRETCHEN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:
Last Name:PETRIE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36108 VINSON RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-5802
Mailing Address - Country:US
Mailing Address - Phone:985-260-1914
Mailing Address - Fax:
Practice Address - Street 1:432 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-2189
Practice Address - Country:US
Practice Address - Phone:504-329-2859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6716101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional