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General NPI Number Information
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NPI Number | 1952933244
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Entity Type | Individual
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Provider Name | KATHRYN ANN PETTERSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2020
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Last Update Date | 02/05/2020
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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 | 1241 BAYNES POINT DR
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City | SUWANEE
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State | GA
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Zip | 30024-2848
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Country | US
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Telephone | 404-606-3247
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Fax | 770-497-0130
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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 | 2113
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License Number State | GA
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