Healthcare Provider Details

I. General information

NPI: 1164203337
Provider Name (Legal Business Name): CHLOE MARLIES PETERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHLOE MARLIES BIRCH LCSW

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR STE 512
JACKSONVILLE FL
32207-8207
US

IV. Provider business mailing address

PO BOX 748519
ATLANTA GA
30374-8519
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3800
  • Fax:
Mailing address:
  • Phone: 904-376-3800
  • Fax: 904-376-3988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: