Provider Demographics
NPI:1912129453
Name:PETRINI, RUDOLF HARALD WILHELM (LPC)
Entity Type:Individual
Prefix:MR
First Name:RUDOLF
Middle Name:HARALD WILHELM
Last Name:PETRINI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4797 SILVER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9594
Mailing Address - Country:US
Mailing Address - Phone:336-668-2459
Mailing Address - Fax:
Practice Address - Street 1:1301 CAROLINA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1032
Practice Address - Country:US
Practice Address - Phone:336-272-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional