Provider Demographics
NPI:1275426959
Name:PETRO, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PETRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 MACMILLAN AVE N APT 2D
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5272
Mailing Address - Country:US
Mailing Address - Phone:708-698-0208
Mailing Address - Fax:
Practice Address - Street 1:6740 ROCK SPRING RD BLDG IV
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3185
Practice Address - Country:US
Practice Address - Phone:910-390-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBACB1291918106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician