| NPI | 1245398668 |
|---|---|
| Former Name | CONNIE FAIRCHILD PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO LPC1385) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 5708CAC) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2014-09-23 |