Doctor Name: | SABRINA PEDEN |
NPI Number: | 1245424001 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 149 011884 |
Business Practice Address: | 16408 School St South Holland, IL - 604732321 |
Business Phone Number: | 7083393551 |
Business Fax Number: | |
Mailing Address: | 16408 School St, SOUTH HOLLAND |
State: | IL |
Postal Code: | 604732321 |
Phone Number: | 7083393551 |
Fax Number: | |
NPI Enumeration Date: | 09/04/2007 |
NPI Last Update Date: | 04/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 149 011884 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |