Organization Name: | CHRISTINE R PETRO, PSY.D., LLC |
NPI Number: | 1023341518 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTINE R PETRO (PSYCHOLOGIST) |
Mailing Address: | 752 Holcomb Bridge Rd Norcross |
State: | GA US |
Postal Code: | 300711325 |
Phone Number: | 7707852545 |
Fax Number: | |
NPI Enumeration Date: | 09/15/2009 |
NPI Last Update Date: | 09/15/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TB0200X |
License Number: | PSY003011 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Cognitive & Behavioral |
Taxonomy Definition: |