Provider Demographics
NPI:1982849725
Name:PETERS, DAVID L (LAC, LMBT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:PETERS
Suffix:
Gender:M
Credentials:LAC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 GLENMACIE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5136
Mailing Address - Country:US
Mailing Address - Phone:919-274-8054
Mailing Address - Fax:
Practice Address - Street 1:401 KEISLER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7084
Practice Address - Country:US
Practice Address - Phone:919-274-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist