=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285945675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARREN PETERSON M.A., M.S., LPC-I
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2010
-----------------------------------------------------
Last Update Date | 06/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 CENTURY DR STE 215A
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-963-8830
-----------------------------------------------------
Fax | 864-963-8830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 CIRCLE SLOPE DR
-----------------------------------------------------
City | SIMPSONVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29681-5854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-963-8830
-----------------------------------------------------
Fax | 864-963-8830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 5140
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------