MEDICARE: DOROTHY BOLING PETTERS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC002764	GA

General Provider Information

NPI Number	:	1346397627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY BOLING PETTERS LPC

Provider Business Mailing Address
First Line	:	3525 PIEDMONT RD.
Second Line	:	BLDG. 8, SUITE 102
City	:	ATLANTA
State	:	GA
Zip	:	30305
Country	:	US
Telephone Number	:	404-351-0199
Fax Number	:	404-848-9974

Provider Business Practice Location Address
First Line	:	3525 PIEDMONT ROAD, NE
Second Line	:	BLDG. 8, SUITE 102
City	:	ATLANTA
State	:	GA
Zip	:	30305-1533
Country	:	US
Telephone Number	:	404-351-0199
Fax Number	:	404-848-9974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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