Provider Demographics
NPI:1588124416
Name:PETERSON, DEANDREA DICKENS (LPC)
Entity type:Individual
Prefix:
First Name:DEANDREA
Middle Name:DICKENS
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 S EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3404
Mailing Address - Country:US
Mailing Address - Phone:334-435-3982
Mailing Address - Fax:334-460-0899
Practice Address - Street 1:2330 MONTGOMERY HWY STE 2
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-3250
Practice Address - Country:US
Practice Address - Phone:334-435-3982
Practice Address - Fax:334-460-0899
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC04799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional