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General NPI Number Information
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NPI Number | 1063010528
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Entity Type | Individual
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Provider Name | KARLA M PETERSON
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 3790 OLD US HWY 41 N , STE A
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City | VALDOSTA
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State | GA
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Zip | 31602-6865
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Country | US
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Telephone | 229-262-1000
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Fax | 229-262-1085
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Provider Business Mailing Address
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Address Line | 3569 SUMNER RD
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City | MOULTRIE
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State | GA
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Zip | 31768-0117
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Country | US
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Telephone | 229-310-5065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001984
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License Number State | GA
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