Provider Demographics
NPI:1568733186
Name:PARKER, DIANE LOUISE (CCLS)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LOUISE
Last Name:PARKER
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 COMMONWEALTH AVE
Mailing Address - Street 2:APT 21
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5322
Mailing Address - Country:US
Mailing Address - Phone:770-639-1251
Mailing Address - Fax:
Practice Address - Street 1:2709 COMMONWEALTH AVENUE
Practice Address - Street 2:APARTMENT 21
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205
Practice Address - Country:US
Practice Address - Phone:770-639-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist