| Doctor Name: | MATTHEW PETERSON |
| NPI Number: | 1184053365 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC-A, LCAS-A |
| License Number: | A10059 |
| Business Practice Address: | 932 Old Us 70 W Black Mountain, NC - 287112547 |
| Business Phone Number: | 8286694161 |
| Business Fax Number: | 8286694164 |
| Mailing Address: | 665 W 4th St, WINSTON SALEM |
| State: | NC |
| Postal Code: | 271012701 |
| Phone Number: | 8286694161 |
| Fax Number: | 8286694164 |
| NPI Enumeration Date: | 11/07/2013 |
| NPI Last Update Date: | 07/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | A10059 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |