Provider Demographics
NPI:1962858902
Name:PETERS, DANA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 GRAND AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4400
Mailing Address - Country:US
Mailing Address - Phone:858-333-7980
Mailing Address - Fax:
Practice Address - Street 1:1767 GRAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4400
Practice Address - Country:US
Practice Address - Phone:858-333-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT92641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist