MR. KEVIN LEON PETERSEN (NPI# 1356676290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356676290 |
| Entity Type | Individual |
| Full Name | MR. KEVIN LEON PETERSEN |
| Credential | PSY.D. |
| Practice Address |
6439 Garners Ferry Road Wjbd Va Medical Center Columbia SC 29209 |
| Mailing Address |
115 Red Coat Ln Columbia SC 29223-2827 |
| Practice Telephone | 8037764000 |
| Mailing Telephone | 6027905900 |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2009-10-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356778419 | Kevin Thomas Petersen | Surgery | 620 John Paul Jones Cir Dept General, Portsmouth, VA 23708-2197 | 2013-10-03 |
| 1457655680 | Kevin W Petersen | Marriage & Family Therapist | 1420 S Clarkson St, Denver, CO 80210-2237 | 2011-01-03 |
| 1255861126 | Kevin Scott Petersen | Physical Therapist | 3160 8th St Sw Ste M&n, Altoona, IA 50009-1023 | 2017-06-14 |
| 1578759270 | Kevin Lee Petersen | Counselor | 401 16th St Se, Rochester, MN 55904-7973 | 2007-09-18 |
| 1851414346 | Kevin E. Petersen | Chiropractor | 29 Lake St S, Big Lake, MN 55309-4588 | 2007-04-09 |
| 1205971066 | Kevin Petersen | Specialist | 653 N Town Center Dr, Las Vegas, NV 89144-0514 | 2007-02-20 |
| Street Address |
6439 GARNERS FERRY ROAD WJBD VA MEDICAL CENTER |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962480590 | Ambika Rao | Internal Medicine | 6439 Garners Ferry Road, Bldg 100, Rm5c100b, Columbia, SC 29209-1613 | 2006-01-04 |
| 1790345429 | Leslie Kinder | Optometrist | 6439 Garners Ferry Road, Columbia, SC 29209-1639 | 2019-06-14 |
| 1346749140 | Ashley Mccall | Social Worker | 6439 Garners Ferry Road, Columbia, SC 29209 | 2018-02-07 |
| 1831612118 | Shari N Dade | Psychologist | 6439 Garners Ferry Road, Columbia, SC 29209 | 2017-07-19 |
| 1518320852 | Dionne Sanders | Social Worker | 6439 Garners Ferry Road, Columbia, SC 29209 | 2016-04-04 |
| 1679957195 | Jeffrey Earl Musick | Psychologist | 6439 Garners Ferry Road, Dorn Va Medical Center, Columbia, SC 29209 | 2015-07-14 |
| 1538559836 | Danielle Chandler Sokol | Physical Therapy Assistant | 6439 Garners Ferry Road, Wm. Jennings Bryan Dorn Va Medical Center, Columbia, SC 29209-1639 | 2015-01-26 |
| 1093065872 | Katherine Lorraine Ruth | Occupational Therapist | 6439 Garners Ferry Road, Columbia, SC 29209 | 2012-09-19 |
| 1689923302 | Cristen Hudson | Dietitian, Registered | 6439 Garners Ferry Road, Columbia, SC 29209 | 2012-09-10 |
| 1811246432 | Jamie Elizabeth Rickards | Pharmacist | 6439 Garners Ferry Road, Wjb Dorn Va Medical Center, Columbia, SC 29223 | 2012-08-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992293013 | Pertile Group LLC | Family Medicine | 26 Foot Point Rd, Columbia, SC 29209 | 2018-04-24 |
| 1083156061 | Derek Clark | Physical Therapist | 6349 Garners Ferry Rd, Columbia, SC 29209 | 2016-11-08 |
| 1922450345 | Heather Alexander | Social Worker | 6439 Garners-ferry Road, Suite 122, Wjb Dorn Va, Columbia, SC 29209 | 2016-07-09 |
| 1265888325 | Daphne Elaine Allen | Counselor | 1850 Pinview Dr, Columbia, SC 29209 | 2016-05-09 |
| 1659757649 | Marc Edmundson | Pharmacist | 500 Gills Creek Pkwy #810, Columbia, SC 29209 | 2015-08-03 |
| 1477949113 | Winter Years Home Health Care Agency, LLC | Home Health | 1101 1st Street, P, Columbia, SC 29209 | 2015-04-09 |
| 1285045773 | Alireza Adhami | Pharmacist | 7235 Garners Ferry Rd, Columbia, SC 29209 | 2014-05-19 |
| 1790039212 | Immediate Dental Group Columbia | Dentist | 1118 Greenlawn Drive, Columbia, SC 29209 | 2012-11-06 |
| 1275896284 | Tariq Horani | Internal Medicine | 6349 Garners Ferry Road, Int Med -, Columbia, SC 29209 | 2012-06-25 |
| 1902165467 | Medcare Urgent Care Center Garners Ferry, LLC | Clinic/Center | 7418 Garners Ferry Road, Columbia, SC 29209 | 2012-05-03 |
| Find all providers in zip 29209 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003413493 | Dominica B Hernandez | Psychologist | 4 Doubleday Rd, Columbia, CT 06237-1405 | 2020-10-08 |
| 1326653957 | Brittany A Soto | Psychologist | 2038 Lake Murray Blvd Apt 8203, Columbia, SC 29212-0843 | 2020-09-10 |
| 1740894427 | Shraddha Niphadkar | Psychologist | 406 South 6th Street 119 Parker Hall, Columbia, MO 65211-0001 | 2020-09-01 |
| 1003424474 | Minds Matter Psychological Services | Psychologist | 10015 Old Columbia Rd Ste B33, Columbia, MD 21046-1703 | 2020-07-21 |
| 1457987828 | Anne Marie Zwycewicz | Psychologist | 6510 Belleview Dr, Columbia, MD 21046-1000 | 2020-03-18 |
| 1932757127 | Brienne Allen Schaeffer | Psychologist | 1409 Devine St Fl 3, Columbia, SC 29208-3902 | 2019-08-30 |
| 1285192120 | Doris Paez | Psychologist | 1024 Wildwood Centre Dr Ste A, Columbia, SC 29229-8400 | 2019-03-11 |
| 1801354188 | Better Self Counseling LLC | Psychologist | 8640 Guilford Rd Ste 220, Columbia, MD 21046-2671 | 2019-03-06 |
| 1942767538 | Jennifer Nicole Merrifield | Psychologist | 6439 Garners Ferry Rd Bldg 106, Columbia, SC 29209-1638 | 2019-03-01 |
| 1346711439 | Natalie Gwin | Psychologist | 10630 Little Patuxent Pkwy Ste 310, Columbia, MD 21044-3264 | 2018-12-16 |
| Find all providers in COLUMBIA | ||||
Please comment or provide details below to improve the information on MR. KEVIN LEON PETERSEN.
| 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.