Provider Demographics
NPI:1710220660
Name:PARKER, MARRIONETTIA DAVIS (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARRIONETTIA
Middle Name:DAVIS
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3274
Mailing Address - Country:US
Mailing Address - Phone:803-473-6613
Mailing Address - Fax:
Practice Address - Street 1:2065 BLOSSOM ST
Practice Address - Street 2:SUITE 204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2220
Practice Address - Country:US
Practice Address - Phone:803-473-6613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional