Provider Demographics
NPI:1659610103
Name:PARKER, ISRAEL JEROME V
Entity Type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:JEROME
Last Name:PARKER
Suffix:V
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N HARVIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4956
Mailing Address - Country:US
Mailing Address - Phone:803-775-6815
Mailing Address - Fax:803-773-6232
Practice Address - Street 1:115 N HARVIN ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4956
Practice Address - Country:US
Practice Address - Phone:803-775-6815
Practice Address - Fax:803-773-6232
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
SC13011713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)