Healthcare Provider Details

I. General information

NPI: 1609344399
Provider Name (Legal Business Name): NATASHA PETERSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2018
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4132 E JOPPA RD STE 110-1131
BALTIMORE MD
21236-2272
US

IV. Provider business mailing address

4132 E JOPPA RD STE 110-1131
BALTIMORE MD
21236-2272
US

V. Phone/Fax

Practice location:
  • Phone: 410-260-0667
  • Fax:
Mailing address:
  • Phone: 410-260-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC9091
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9091
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: