Individual provider · Type 1 NPI

Charles Randolph Petersen

Mental Health Counselor · Clarkston, WA

NPI number 1417578014 Active

Practice location

900 7th St
Clarkston, WA 99403-2005

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1417578014

Charles Randolph Petersen's National Provider Identifier is 1417578014, issued on May 5, 2020. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Clarkston, WA. The record was last updated on May 5, 2020.