Provider Demographics
NPI:1851179089
Name:CHRISTINE IRENE PETERSON, LLC
Entity Type:Organization
Organization Name:CHRISTINE IRENE PETERSON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMSW
Authorized Official - Phone:517-262-9178
Mailing Address - Street 1:209 E WASHINGTON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2393
Mailing Address - Country:US
Mailing Address - Phone:517-262-9178
Mailing Address - Fax:517-748-7188
Practice Address - Street 1:209 E WASHINGTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2393
Practice Address - Country:US
Practice Address - Phone:517-262-9178
Practice Address - Fax:517-748-7188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty