Damon Peterson, M.ED, PBSF

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

148 Issued in VA

Practice address

24812 Brickwood Meadow LN
Petersburg, VA 23803-8869

Phone

(804) 861-5201

NPI assigned

Apr 24, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272067200000",
    "number": "1194042515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 334",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238040334",
            "telephone_number": "804-861-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24812 BRICKWOOD MEADOW LN",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238038869",
            "telephone_number": "804-861-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "DAMON",
        "credential": "M.ED, PBSF",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-24",
        "last_updated": "2010-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0160289598",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Petersburg Hospital Company LLC
• Petersburg Hospital Company LLC
• Petersburg Pathology Associates LTD.
• Petersburg Pharmacy PLLC
• Petersburg Public Schools
• Tammy Faye Peterson
• Heather M Pettis, M.D.
• Latisha Renee Petty
• Justin Andrew Phillingane, D.P.M.
• Sarah Neal Phillips

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.