Provider Demographics
NPI:1396586640
Name:PETERMANN, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:PETERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 CHAPEL RIDGE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8627
Mailing Address - Country:US
Mailing Address - Phone:919-355-9792
Mailing Address - Fax:
Practice Address - Street 1:1480 CHAPEL RIDGE RD STE 220
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8627
Practice Address - Country:US
Practice Address - Phone:919-355-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty