Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0388 | NH |
NPI | 1003945361 |
---|---|
Provider Name | Ms. Dana Patrice Peters |
First Address | Portsmouth, NH 03801-4847 |
Second Address | Portsmouth, NH 03801-7237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 30/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14Y001603NH01 | ANTHEM BLUE CROSS BLUE SHIELD (01) | NH |