Provider Demographics
NPI:1386221877
Name:PARKER, PHAGAN MARNEI' (NCC, LCMHCA, CSAC)
Entity Type:Individual
Prefix:MS
First Name:PHAGAN
Middle Name:MARNEI'
Last Name:PARKER
Suffix:
Gender:F
Credentials:NCC, LCMHCA, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 WATERFORD HILLS DR APT 1322
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1506
Mailing Address - Country:US
Mailing Address - Phone:252-395-0095
Mailing Address - Fax:
Practice Address - Street 1:1554 UNION RD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5581
Practice Address - Country:US
Practice Address - Phone:980-224-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health