Provider Demographics
NPI:1700097938
Name:PETERS, KATHY EILEEN (CADC II-CA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:EILEEN
Last Name:PETERS
Suffix:
Gender:F
Credentials:CADC II-CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FORENSIC MENTAL HEALTH
Mailing Address - Street 2:2280 DIAMOND BLVD
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-6206
Mailing Address - Country:US
Mailing Address - Phone:925-723-1221
Mailing Address - Fax:
Practice Address - Street 1:2280 DIAMOND BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5750
Practice Address - Country:US
Practice Address - Phone:925-723-1221
Practice Address - Fax:925-608-5984
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA172V00000XMedicaid