Provider Demographics
NPI:1194792580
Name:PETERS, NANCY C (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:C
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6062
Mailing Address - Country:US
Mailing Address - Phone:910-762-9083
Mailing Address - Fax:
Practice Address - Street 1:2450 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6062
Practice Address - Country:US
Practice Address - Phone:910-762-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000101Medicaid
7266127OtherAETNA
900012686OtherPRIORITY HEALTH
071991OtherVALUE OPTIONS
70180OtherMEDCOST
04360OtherBLUE CROSS/BLUE SHIELD
IPO39303OtherMAGELLAN
61-07217OtherUBH
NC6000101Medicaid