Healthcare Provider Details

I. General information

NPI: 1245462498
Provider Name (Legal Business Name): PETER IOTOV D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S GOVERNORS AVE ABR COUNSELING ASSOCIATES
DOVER DE
19904-7020
US

IV. Provider business mailing address

3961 LEIPSIC RD
DOVER DE
19901-2924
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-4558
  • Fax: 302-678-4577
Mailing address:
  • Phone: 302-678-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberFA-0000001
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: