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Damon Peterson, MED,PBSF
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Petersburg, Virginia
NPI 1194042515

Damon Peterson is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Petersburg, VA. Damon Peterson practices in Petersburg, VA and has the professional credentials of MED,PBSF. The NPI Number for Damon Peterson is 1194042515 and holds a License No. 148 (Virginia).

The current practice location address for Damon Peterson is 24812 Brickwood Meadow Ln, Petersburg, VA and can be reached out via phone at 804-861-5201.

Location: 24812 Brickwood Meadow Ln, Petersburg, VA, 23804-0334
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Provider Profile Details
NPI Number
1194042515
Provider Name
Damon Peterson
Credential
MED,PBSF
Provider Entity Type
Individual
Gender
Male
Address
24812 Brickwood Meadow Ln, Petersburg, VA, 23804-0334
Phone Number
804-861-5201
Fax Number
Provider Enumeration Date
04/24/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0160289598 05 VA
institution
Provider Business Practice Location Address Details
Address
24812 Brickwood Meadow Ln
City
State
Zip
23803-8869
Phone Number
804-861-5201
Fax Number
person
Provider Business Mailing Address Details
Address
24812 Brickwood Meadow Ln
City
State
Zip
23803-8869
Phone Number
804-861-5201
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
148 (Virginia)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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