Provider Demographics
NPI:1235570581
Name:PARKER, SHERQUANTA LATROYA (LCSW-A)
Entity Type:Individual
Prefix:
First Name:SHERQUANTA
Middle Name:LATROYA
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 PARK GLEN DR
Mailing Address - Street 2:APT 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1069
Mailing Address - Country:US
Mailing Address - Phone:252-916-1389
Mailing Address - Fax:336-395-8501
Practice Address - Street 1:1205 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6958
Practice Address - Country:US
Practice Address - Phone:336-514-9493
Practice Address - Fax:336-395-8501
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP008228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health