Provider Demographics
NPI:1720674575
Name:PETTIGREW, KATRINA DAWN (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:DAWN
Last Name:PETTIGREW
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:DAWN
Other - Last Name:MALCOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:425 E SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1619
Mailing Address - Country:US
Mailing Address - Phone:304-543-0847
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 189
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0434
Practice Address - Country:US
Practice Address - Phone:517-272-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011051241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical