Provider Demographics
NPI:1700097938
Name:PETERS, KATHY EILEEN (CADC II-CA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:EILEEN
Last Name:PETERS
Suffix:
Gender:F
Credentials:CADC II-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 FELICE CIR
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-6206
Mailing Address - Country:US
Mailing Address - Phone:707-695-0632
Mailing Address - Fax:
Practice Address - Street 1:1220 MORELLO AVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4707
Practice Address - Country:US
Practice Address - Phone:925-335-3330
Practice Address - Fax:925-608-5984
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA172V00000XMedicaid