Provider Demographics
NPI:1740329176
Name:PETRO, CHRISTINE RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:RENEE
Last Name:PETRO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LAURENS RD STE D
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-1860
Mailing Address - Country:US
Mailing Address - Phone:864-668-2505
Mailing Address - Fax:864-305-3010
Practice Address - Street 1:109 LAURENS RD STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1860
Practice Address - Country:US
Practice Address - Phone:864-668-2505
Practice Address - Fax:864-305-3010
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003011103TC0700X, 103TC2200X
SC1840103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA668652382AMedicaid
GA668652382CMedicaid
GA668652382EMedicaid