CHRISTINE R PETRO, PSY.D., LLC (NPI# 1023341518) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023341518 |
| Entity Type | Organization |
| Organization Name | CHRISTINE R PETRO, PSY.D., LLC |
| Practice Address |
69 Grayson New Hope Rd Grayson GA 30017 |
| Mailing Address |
69 Grayson New Hope Rd Grayson GA 30017-1363 |
| Practice Telephone | 7707852545 |
| Mailing Telephone | 7707852545 |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2018-06-08 |
| Authorized Official Name | CHRISTINE RENEE PETRO (PSY.D.) |
| Authorized Official Telephone | 7707852545 |
| Authorized Official Credential | PSY.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
PSY003011 | GA | Behavioral Health & Social Service Providers |
| N | 103TC0700X |
Psychologist Specialization: Clinical |
PSY003011 | GA | Behavioral Health & Social Service Providers |
| N | 103TF0000X |
Psychologist Specialization: Family |
PSY003011 | GA | Behavioral Health & Social Service Providers |
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
PSY003011 | GA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 668652382C | 05 | |
| GA | 668652382E | 05 |
| Street Address |
69 GRAYSON NEW HOPE RD |
| City | GRAYSON |
| State | GA |
| Zip Code | 30017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588140859 | Butterfly Development, LLC | Community Based Residential Treatment Facility, Mental Illness | 1911 Grayson Highway, Suite 8-242, Grayson, GA 30017 | 2018-07-19 |
| 1811417132 | Yva Gauthier | Nurse Practitioner | 1620 Terry Mill Lane, Grayson, GA 30017 | 2017-06-27 |
| 1902097579 | Zain Odeh Dabbas | Dentist | 2594 Loganviile Hwy, # 102, Grayson, GA 30017 | 2007-08-07 |
| 1619078276 | Primary Foot & Ankle Care | Podiatrist | 862 Amber Hill Ct, Grayson, GA 30017 | 2006-09-26 |
| 1700878170 | James Michael Long | Dentist | 2518 Loganville Hwy, Grayson, GA 30017 | 2005-08-22 |
| 1629556717 | Mason Moriah Earp | Physical Therapist | 2065 Grayson Hwy Ste B, Grayson, GA 30017 | 2018-08-01 |
| 1811482201 | Matthew Ntomoo Lo | Physical Therapy Assistant | 2065 Grayson Hwy Ste B, Grayson, GA 30017 | 2018-06-27 |
| 1144460668 | Alisa M Nelson-wade | Dentist | 2219 Loganville Hwy, Hwy 20, Grayson, GA 30017 | 2009-02-24 |
| 1003321662 | Grace Care Ambulance Transport, LLC | Ambulance | 516 Sosebee Farm Rd Unit 531, Grayson, GA 30017-0118 | 2017-12-05 |
| 1053856377 | Karen Gibbs-burton | Pharmacist | 516 Sosebee Farm Rd Unit 1426, Grayson, GA 30017-0154 | 2016-12-21 |
| Find all providers in zip 30017 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538693254 | Rachel Yosick | Psychologist | 520 Wembley Cir, Sandy Springs, GA 30328-6753 | 2017-04-19 |
| 1174974620 | Warren Umansky, Ph.d. | Psychologist | 302 Wheeler Executive Ctr, Augusta, GA 30909 | 2016-06-27 |
| 1245655893 | Tiffany Gilmore Randell | Psychologist | 101 Devant Street, Office 401, Fayetteville, GA 30214 | 2014-02-19 |
| 1972927861 | Tyrone D. Lane Enterprises, Incorporated | Psychologist | 5304 Panola Industrial Boulevard, Suite L, Decatur, GA 30035 | 2014-02-12 |
| 1720409493 | Tonya Favors | Psychologist | 311 S Lee St, Apt C, Americus, GA 31709-3971 | 2013-12-26 |
| 1912336546 | Francine Adams | Psychologist | 324 Trace Ln, Lawrenceville, GA 30046-2896 | 2013-11-04 |
| 1447542691 | Erin Marie Jones | Psychologist | 1256 Briarcliff Rd Ne Ste 322e, Atlanta, GA 30306-2636 | 2011-05-06 |
| 1164729901 | Tiffany Whitworth | Psychologist | 4139 Hospital Dr Ne, Covington, GA 30014-2565 | 2011-02-14 |
| 1548573264 | Kimberley Blaker Saye | Psychologist | 4695 Mahonia Way Nw, Acworth, GA 30102-3575 | 2010-07-22 |
| 1316269350 | Caitlin Herzinger Delfs | Psychologist | 4994 Lower Roswell Rd Ste 10, Marietta, GA 30068-4332 | 2010-02-18 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CHRISTINE R PETRO, PSY.D., LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.