Provider Demographics
NPI:1912777095
Name:PETERSON, DONITA SADE' (MSW, LMHP-S)
Entity Type:Individual
Prefix:
First Name:DONITA
Middle Name:SADE'
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MSW, LMHP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 PATRIOTS WALKE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-2365
Mailing Address - Country:US
Mailing Address - Phone:757-718-3371
Mailing Address - Fax:
Practice Address - Street 1:1545 CROSSWAYS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0218
Practice Address - Country:US
Practice Address - Phone:757-718-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker