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Charles Randolph Petersen
Mental Health Counselor in Clarkston, Washington
NPI 1417578014

Charles Randolph Petersen is a Mental Health Counselor based in Clarkston, WA and is specialized in Mental Health. Charles Randolph Petersen practices in Clarkston, WA. The NPI Number for Charles Randolph Petersen is 1417578014 and holds a License No. (Washington).

The current practice location address for Charles Randolph Petersen is 900 7Th St, Clarkston, WA and can be reached out via phone at 508-758-3341.

Location: 900 7Th St, Clarkston, WA, 99403-2005
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1417578014
Provider Name
Charles Randolph Petersen
Credential
Provider Entity Type
Individual
Gender
Male
Address
900 7Th St, Clarkston, WA, 99403-2005
Phone Number
508-758-3341
Fax Number
Provider Enumeration Date
05/05/2020
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
900 7Th St
City
Clarkston
State
Washington
Zip
99403-2005
Phone Number
508-758-3341
Fax Number
person
Provider Business Mailing Address Details
Address
900 7Th St
City
Clarkston
State
Washington
Zip
99403-2005
Phone Number
508-758-3341
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
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