MEDICARE: MR. DEMETRIOS N PERATSAKIS PD, MS, LPC

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
1	101YP2500X	Professional Counselor	0701002438	VA

General Provider Information

NPI Number	:	1215222716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEMETRIOS N PERATSAKIS PD, MS, LPC

Provider Business Mailing Address
First Line	:	5268 GODWIN BLVD
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8114
Country	:	US
Telephone Number	:	757-255-7126
Fax Number	:

Provider Business Practice Location Address
First Line	:	5268 GODWIN BLVD
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-8114
Country	:	US
Telephone Number	:	757-255-7126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	06/13/2011

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