Kathryn Ann Petterson, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2113 Issued in GA

Practice address

295 S Culver St Ste D
Lawrenceville, GA 30046-3239

Phone

(770) 995-5555

Fax

(770) 497-0130

NPI assigned

Feb 5, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 5, 2024 through Apr 5, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Kathryn Petterson LLC

  • Counselor
  • Lawrenceville, GA
  • NPI 1568529170
  NPD Authorized official

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1952933244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1241 BAYNES POINT DR",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300242848",
            "telephone_number": "404-606-3247",
            "fax_number": "770-497-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 S CULVER ST STE D",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463239",
            "telephone_number": "770-995-5555",
            "fax_number": "770-497-0130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSON",
        "first_name": "KATHRYN",
        "middle_name": "ANN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-05",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "2113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Seth William Peterson
• Loritz Petit-Homme
• Richard G Petit, P.A.
• Mary Petner, LMSW
• Carolyn Barnwell Petrey, DO
• Faresa N Petti Daniel, COTA
• Donald Minh Pham, M.D.
• Hongvien Pham, PHARM D
• Jamila-Duyen P Pham, MD
• Jessica Pham, PHARM D

• Mental Health Counselor in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.