Provider Demographics
NPI:1346398096
Name:PARRIS, MENA ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:MENA
Middle Name:ANGELA
Last Name:PARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:M.
Other - Middle Name:ANGELA
Other - Last Name:PARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4022 TECOLOTE WAY
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8327
Mailing Address - Country:US
Mailing Address - Phone:919-451-5912
Mailing Address - Fax:
Practice Address - Street 1:433 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3217
Practice Address - Country:US
Practice Address - Phone:919-451-5912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004543 (SOCIAL WORK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106165Medicaid