| Kathryn Petterson Llc | |
|
295 S Culver St Ste D Lawrenceville GA 30046-3239 | |
| (770) 995-5555 | |
| (770) 497-0130 |
| Full Name | Kathryn Petterson Llc |
|---|---|
| Speciality | Counselor |
| Location | 295 S Culver St Ste D, Lawrenceville, Georgia |
| Authorized Official Name and Position | Kathryn Ann Petterson (PRESIDENT) |
| Authorized Official Contact | 4046063247 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathryn Petterson Llc 295 S Culver St Ste D Lawrenceville GA 30046-3239 Ph: (770) 995-5555 | Kathryn Petterson Llc 295 S Culver St Ste D Lawrenceville GA 30046-3239 Ph: (770) 995-5555 |
| NPI Number | 1568529170 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 05/22/2020 |
| Certification Date | 05/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568529170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | LPC2113 (Georgia) | Primary |
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