Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | AC0090 | MD |
NPI | 1003355074 |
---|---|
Provider Name | Gregory Peters |
First Address | Cumberland, MD 21502-8339 |
Second Address | Cumberland, MD 21502-8339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2017 |
Last Update Date | 23/02/2017 |