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General NPI Number Information
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NPI Number | 1174867022
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Entity Type | Individual
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Provider Name | KASEY GRAHAM PETERSEN BCABA
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 89 OLD TROLLEY RD # B 202
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City | SUMMERVILLE
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State | SC
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Zip | 29485-4951
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Country | US
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Telephone | 843-875-0017
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Fax | 843-486-8394
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Provider Business Mailing Address
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Address Line | 401 MATHER GREEN AVE APT C
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City | CHARLOTTE
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State | NC
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Zip | 28203-5676
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Country | US
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Telephone | 803-524-9715
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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