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General NPI Number Information
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NPI Number | 1568529170
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Entity Type | Organization
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Legal Business Name | KATHRYN PETTERSON LLC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 295 S CULVER ST STE D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3239
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Country | US
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Telephone | 770-995-5555
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Fax | 770-497-0130
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Provider Business Mailing Address
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Address Line | 295 S CULVER ST STE D
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-3239
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Country | US
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Telephone | 770-995-5555
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Fax | 770-497-0130
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KATHRYN ANN PETTERSON
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Credential | PHD
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Telephone | 404-606-3247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC2113
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License Number State | GA
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