Provider Demographics
NPI:1851833297
Name:PARKER, MICHELLE C (LISW-CP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:PARKER
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WATERMARK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-2574
Mailing Address - Country:US
Mailing Address - Phone:206-305-7455
Mailing Address - Fax:
Practice Address - Street 1:1415 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3803
Practice Address - Country:US
Practice Address - Phone:843-450-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605764221041C0700X
SC159101041C0700X
TX628381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical