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General NPI Number Information
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NPI Number | 1720890726
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Entity Type | Individual
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Provider Name | ALEXANDRIA GRAYCE PETERSEN MA, LLC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 675 E BIG BEAVER RD STE 207
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City | TROY
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State | MI
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Zip | 48083-1428
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Country | US
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Telephone | 248-677-1421
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E WINDEMERE AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-2618
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Country | US
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Telephone | 248-310-8128
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451024099
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License Number State | MI
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