Healthcare Provider Details

I. General information

NPI: 1760263941
Provider Name (Legal Business Name): DEVIN ELIZABETH PETERSON LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 FEDERAL RD STE B
BROOKFIELD CT
06804-1847
US

IV. Provider business mailing address

828 FEDERAL RD STE B
BROOKFIELD CT
06804-1847
US

V. Phone/Fax

Practice location:
  • Phone: 800-611-0185
  • Fax: 800-930-5241
Mailing address:
  • Phone: 800-611-0185
  • Fax: 800-930-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: