Provider Demographics
NPI:1891396867
Name:PETERS, COLETTE S (LICSW, PIP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:S
Last Name:PETERS
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-7445
Mailing Address - Country:US
Mailing Address - Phone:205-535-0168
Mailing Address - Fax:
Practice Address - Street 1:300 59TH ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-7445
Practice Address - Country:US
Practice Address - Phone:205-535-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2334C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical