Provider Demographics
NPI:1790229078
Name:PETERSON, NONA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:NONA
Middle Name:LYNN
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 1:413 4TH AVE S STE 16
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-5755
Mailing Address - Country:US
Mailing Address - Phone:662-418-5909
Mailing Address - Fax:
Practice Address - Street 1:413 4TH AVE S STE 16
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-5755
Practice Address - Country:US
Practice Address - Phone:662-418-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional