Healthcare Provider Details

I. General information

NPI: 1326766718
Provider Name (Legal Business Name): ADRIENNE PETERSEN M.PSY.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/19/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 KEY WEST AVE STE 100
ROCKVILLE MD
20850-3992
US

IV. Provider business mailing address

9707 KEY WEST AVE STE 100
ROCKVILLE MD
20850-3992
US

V. Phone/Fax

Practice location:
  • Phone: 240-750-6467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: