Provider Demographics
NPI:1306380746
Name:PARKER, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 GAINES SCHOOL RD
Mailing Address - Street 2:SUITE A4C
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3198
Mailing Address - Country:US
Mailing Address - Phone:706-614-3132
Mailing Address - Fax:
Practice Address - Street 1:1060 GAINES SCHOOL RD
Practice Address - Street 2:SUITE A4C
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3198
Practice Address - Country:US
Practice Address - Phone:706-614-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-04
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0058641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical