MRS. Tina Yvonne Pettiford, LPC

NPI #1366711939 in East Saint Louis, Illinois

Provider Information

NPI Number: 1366711939
Entity Type: Individual
Name: MRS. Tina Yvonne Pettiford, LPC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor - Professional
Credential: LPC
Enumeration Date: Dec 27, 2011
Last Updated: Dec 27, 2011

Practice Location

Address: 5501 N PARK DR
City: East Saint Louis
State: Illinois
ZIP Code: 62204-2121
Phone: (618) 244-5119

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X
Counselor - Mental Health — Mental Health	101YM0800X
Counselor - Professional — Professional	101YP2500X	Primary
Counselor - School — School	101YS0200X
Marriage & Family Therapist	106H00000X

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