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General NPI Number Information
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NPI Number | 1851179089
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Entity Type | Organization
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Legal Business Name | CHRISTINE IRENE PETERSON, LLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 209 E WASHINGTON AVE STE 330-C
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City | JACKSON
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State | MI
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Zip | 49201-2393
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Country | US
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Telephone | 517-262-9178
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Fax | 517-748-7188
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Provider Business Mailing Address
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Address Line | 209 E WASHINGTON AVE STE 330-C
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City | JACKSON
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State | MI
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Zip | 49201-2393
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Country | US
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Telephone | 517-262-9178
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Fax | 517-748-7188
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE IRENE PETERSON
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Credential | LCMSW
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Telephone | 517-262-9178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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