Roderick Dejuan Peterson Sr., MA, LLPC, CAAC, CCSM

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1972368 Issued in MI

Practice address

7845 Middlebelt Rd Ste 201
Romulus, MI 48174-2174

Phone

(734) 721-0900

NPI assigned

Feb 20, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Motivational Empowerment Counseling Center & Associates

  • Community/Behavioral Health Agency
  • Romulus, MI
  • NPI 1295915643
  NPD (past) Authorized official

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1679742928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7845 MIDDLEBELT RD STE 201",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481742174",
            "telephone_number": "734-721-0900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7845 MIDDLEBELT RD STE 201",
            "city": "ROMULUS",
            "state": "MI",
            "postal_code": "481742174",
            "telephone_number": "734-721-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "RODERICK",
        "middle_name": "DEJUAN",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "MA, LLPC, CAAC, CCSM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "S-10019",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "C-00234",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "1972368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ladonna Payne
• Tena Payton-Vance
• Marie-Eve Pepin
• Charlette Perkins
• Kevin Person
• Darnesha Pickens, LMSW
• Shawnell Pinkston
• Ellen Louise Plesko
• David F Pommerening, MD
• Donna Letrice Ponder

• Professional Counselor in Romulus, MI
• Providers in Romulus, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.