Provider Demographics
NPI:1114071727
Name:PARKER, R CLIFFORD JR (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:CLIFFORD
Last Name:PARKER
Suffix:JR
Gender:M
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-8070
Mailing Address - Country:US
Mailing Address - Phone:336-883-1361
Mailing Address - Fax:336-883-0065
Practice Address - Street 1:338 BURTON AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-8070
Practice Address - Country:US
Practice Address - Phone:336-883-1361
Practice Address - Fax:336-883-0065
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC788101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102509Medicaid