Provider Demographics
NPI:1760263941
Name:PETERSON, DEVIN ELIZABETH (LPC-A)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:ELIZABETH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 FEDERAL RD STE B
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1847
Mailing Address - Country:US
Mailing Address - Phone:800-611-0185
Mailing Address - Fax:800-930-5241
Practice Address - Street 1:828 FEDERAL RD STE B
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-1847
Practice Address - Country:US
Practice Address - Phone:800-611-0185
Practice Address - Fax:800-930-5241
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)