Provider Demographics
NPI:1245462498
Name:IOTOV, PETER (DMIN)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:IOTOV
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 LEIPSIC RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-2924
Mailing Address - Country:US
Mailing Address - Phone:302-678-9831
Mailing Address - Fax:
Practice Address - Street 1:1550 S GOVERNORS AVE
Practice Address - Street 2:ABR COUNSELING ASSOCIATES
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7020
Practice Address - Country:US
Practice Address - Phone:302-678-4558
Practice Address - Fax:302-678-4577
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFA-0000001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist