Provider Demographics
NPI:1841755584
Name:PETERSON, DANNA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:MARIE
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 1:2701 E ANDY DEVINE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4889
Mailing Address - Country:US
Mailing Address - Phone:602-510-0665
Mailing Address - Fax:
Practice Address - Street 1:2701 E ANDY DEVINE AVE STE 108
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4889
Practice Address - Country:US
Practice Address - Phone:602-510-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC17750101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor