Damon Peterson M.ED, PBSF

NPI 1194042515 - Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities - 320900000X

NPI Details
NPI 1194042515
Gender Male
Enumeration Date 04/24/2010
Last Updated 04/24/2010
Entity Type Individual
Active Over 6 years ago
Practice Location
24812 BRICKWOOD MEADOW LN
PETERSBURG VA, 23803-8869, US
Phone (804) 861-5201
Fax
Business Location
PO BOX 334
PETERSBURG VA, 23804-0334, US
Phone (804) 861-5201
Fax
Toxanomy
Taxonomy Code 320900000X
License State Virginia
License Number 148
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According to our database, Damon Peterson M.ED, PBSF NPI is 1194042515, taxonomy code is 320900000X and license number is 148, license state is located at Virginia. Damon Peterson M.ED, PBSF physically located at 24812 Brickwood Meadow Ln, Petersburg VA, 23803-8869. NPI Number Damon Peterson M.ED, PBSF has the Individual type.

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1194042515 NPI number is provided on an as is basis without warranty of any kind. 1194042515 is maintained by the National Plan & Provider Enumeration System. The contents of Damon Peterson M.ED, PBSF are for informational purposes only.