Healthcare Provider Details

I. General information

NPI: 1912036575
Provider Name (Legal Business Name): DARRIN PETERSON LPCC/LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E MAIN ST
COLUMBUS OH
43215-5349
US

IV. Provider business mailing address

PO BOX 715194
COLUMBUS OH
43271-5194
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8005
  • Fax: 614-355-8030
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0700886
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0027574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: