Provider Demographics
NPI:1710585682
Name:PETERSON, AMBER LEE (LCSWA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 N NC HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8543
Mailing Address - Country:US
Mailing Address - Phone:336-213-4955
Mailing Address - Fax:
Practice Address - Street 1:2207 DELANEY DR STE 107
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5263
Practice Address - Country:US
Practice Address - Phone:336-684-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0150701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical