| Doctor Name: | VERONICA FAYE PETKUS |
| NPI Number: | 1134530934 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, LMHC |
| License Number: | MH12411 |
| Business Practice Address: | 366 E Graves Ave Orange City, FL - 327635266 |
| Business Phone Number: | 3862123643 |
| Business Fax Number: | |
| Mailing Address: | 1733 Arash Cir, PORT ORANGE |
| State: | FL |
| Postal Code: | 321287329 |
| Phone Number: | 3862123643 |
| Fax Number: | |
| NPI Enumeration Date: | 05/14/2014 |
| NPI Last Update Date: | 05/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH12411 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |