Provider Demographics
NPI:1205677549
Name:PETERSON, CHRISTINE ANDREA (MSW, LPSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANDREA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW, LPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6247
Mailing Address - Country:US
Mailing Address - Phone:307-374-4014
Mailing Address - Fax:
Practice Address - Street 1:408 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6247
Practice Address - Country:US
Practice Address - Phone:307-374-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-1158104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker