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NPI Code Detail

MEDICARE: DANIELLE PETERSON

MEDICARE: DANIELLE PETERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor6451023569MI
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1164109609
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE PETERSON
Provider Business Mailing Address
First Line : 443 N STATE ST
Second Line :
City : CARO
State : MI
Zip : 48723-1539
Country : US
Telephone Number : 989-672-6160
Fax Number :
Provider Business Practice Location Address
First Line : 651 N STATE ST
Second Line :
City : CARO
State : MI
Zip : 48723-1584
Country : US
Telephone Number : 989-672-6160
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2023
Last Update Date : 06/04/2026

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Directions to “ DANIELLE PETERSON ” Practice Location

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