Provider Demographics
NPI:1710659339
Name:PARKER, LILLY AMY (BSHS)
Entity Type:Individual
Prefix:MRS
First Name:LILLY
Middle Name:AMY
Last Name:PARKER
Suffix:
Gender:F
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5925
Mailing Address - Country:US
Mailing Address - Phone:704-796-5481
Mailing Address - Fax:
Practice Address - Street 1:455 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5925
Practice Address - Country:US
Practice Address - Phone:704-796-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health