Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | C005991 | NC |
NPI | 1003237124 |
---|---|
Provider Name | Mr. Joseph Peters |
First Address | Wilmington, NC 28409-3155 |
Second Address | Wilmington, NC 28409-3155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2013 |
Last Update Date | 16/12/2013 |