1346397627 NPI number — DOROTHY BOLING PETTERS LPC

Table of content: DOROTHY BOLING PETTERS LPC (NPI 1346397627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346397627 NPI number — DOROTHY BOLING PETTERS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETTERS
Provider First Name:
DOROTHY
Provider Middle Name:
BOLING
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETTERS
Provider Other First Name:
DOROTHY
Provider Other Middle Name:
DIANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346397627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3525 PIEDMONT RD.
Provider Second Line Business Mailing Address:
BLDG. 8, SUITE 102
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-351-0199
Provider Business Mailing Address Fax Number:
404-848-9974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3525 PIEDMONT ROAD, NE
Provider Second Line Business Practice Location Address:
BLDG. 8, SUITE 102
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30305-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-351-0199
Provider Business Practice Location Address Fax Number:
404-848-9974
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC002764 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)