Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC004568 | PA |
NPI | 1003089194 |
---|---|
Provider Name | Loralie Petitti |
First Address | Dubois, PA 15801 |
Second Address | Dubois, PA 15801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 09/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1971426 | HIGHMARK (01) | PA |