Provider Demographics
NPI:1548364151
Name:PETRY, ANNELISE ARCENEAUX (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNELISE
Middle Name:ARCENEAUX
Last Name:PETRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MOOREFIELD PARK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3657
Mailing Address - Country:US
Mailing Address - Phone:804-272-7611
Mailing Address - Fax:804-560-5574
Practice Address - Street 1:720 MOOREFIELD PARK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3657
Practice Address - Country:US
Practice Address - Phone:804-272-7611
Practice Address - Fax:804-560-5574
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040012271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA800002397Medicare ID - Type Unspecified