Charles Randolph Petersen
NPI #1417578014 in Clarkston, Washington
Provider Information
- NPI Number
- 1417578014
- Entity Type
- Individual
- Name
- Charles Randolph Petersen
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Counselor - Mental Health
- Enumeration Date
- May 5, 2020
- Last Updated
- May 5, 2020
Practice Location
- Address
- 900 7TH ST
- City
- Clarkston
- State
- Washington
- ZIP Code
- 99403-2005
- Phone
- (508) 758-3341
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Mental Health — Mental Health |
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