Provider Demographics
NPI:1700331790
Name:NELSON-PETERSON, LIANA (MA, LPC, SATP)
Entity Type:Individual
Prefix:MS
First Name:LIANA
Middle Name:
Last Name:NELSON-PETERSON
Suffix:
Gender:F
Credentials:MA, LPC, SATP
Other - Prefix:MS
Other - First Name:LIANA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4033 VILLAGE PARK DR 1047
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545
Mailing Address - Country:US
Mailing Address - Phone:816-866-0373
Mailing Address - Fax:
Practice Address - Street 1:4033 VILLAGE PARK DR 1047
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545
Practice Address - Country:US
Practice Address - Phone:816-866-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017011689101YM0800X
NC14568101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor