Provider Demographics
NPI:1346086568
Name:KREMIDAS, PETER (MC, APCC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KREMIDAS
Suffix:
Gender:M
Credentials:MC, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2520
Mailing Address - Country:US
Mailing Address - Phone:765-491-4345
Mailing Address - Fax:
Practice Address - Street 1:227 S HALCYON RD STE 101
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3174
Practice Address - Country:US
Practice Address - Phone:765-491-4345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health