Provider Demographics
NPI:1851373328
Name:PETERSON, NADENE (LPC)
Entity Type:Individual
Prefix:DR
First Name:NADENE
Middle Name:
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 1:1008 7 LKS N
Mailing Address - Street 2:P.O. BOX 752
Mailing Address - City:SEVEN LAKES
Mailing Address - State:NC
Mailing Address - Zip Code:27376-9753
Mailing Address - Country:US
Mailing Address - Phone:910-673-3209
Mailing Address - Fax:910-673-1223
Practice Address - Street 1:1008 7 LKS N
Practice Address - Street 2:
Practice Address - City:SEVEN LAKES
Practice Address - State:NC
Practice Address - Zip Code:27376-9753
Practice Address - Country:US
Practice Address - Phone:910-673-3209
Practice Address - Fax:910-673-1223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00552WMedicare ID - Type Unspecified
S14818Medicare UPIN