Provider Demographics
NPI:1326650094
Name:PARKER, KIMBERLY DESHAUN (LCSWA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DESHAUN
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 S GARNETT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4571
Mailing Address - Country:US
Mailing Address - Phone:252-395-5158
Mailing Address - Fax:
Practice Address - Street 1:804 S GARNETT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4571
Practice Address - Country:US
Practice Address - Phone:252-395-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2023-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0149691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical