Provider Demographics
NPI:1164510335
Name:PARKER, ELIZABETH BREARLEY (PHD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BREARLEY
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 KNOB HILL CT.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE,
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6407
Mailing Address - Country:US
Mailing Address - Phone:704-556-7645
Mailing Address - Fax:704-365-9256
Practice Address - Street 1:3335 KNOB HILL CT.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE,
Practice Address - State:NC
Practice Address - Zip Code:28210-6407
Practice Address - Country:US
Practice Address - Phone:704-556-7645
Practice Address - Fax:704-365-9256
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343103TC0700X
NC113106H00000X
NC0343103TC0700X
NC133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03158OtherBCBS
NC03158OtherBCBS