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General NPI Number Information
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NPI Number | 1811384381
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Entity Type | Individual
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Provider Name | CARLA PETREE
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Gender | Female
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 600 8TH AVE W STE 200
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City | PALMETTO
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State | FL
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Zip | 34221-5162
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Country | US
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Telephone | 941-807-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 9952 HYDE GLEN CT
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City | CHARLOTTE
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State | NC
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Zip | 28262-2659
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Country | US
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Telephone |
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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 | MH15954
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License Number State | FL
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