Provider Demographics
NPI:1558365379
Name:PARRISH, DOUGLAS R (LCSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:PARRISH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 RAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5451
Mailing Address - Country:US
Mailing Address - Phone:910-438-0947
Mailing Address - Fax:910-438-0906
Practice Address - Street 1:2577 RAVENHILL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5451
Practice Address - Country:US
Practice Address - Phone:910-609-3700
Practice Address - Fax:910-609-3784
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003299Medicaid
NC6003299Medicaid