Provider Demographics
NPI:1871824151
Name:PARKER, JUSTIN M
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:PARKER
Suffix:
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 1:1901 N HARRISON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5597
Mailing Address - Country:US
Mailing Address - Phone:919-677-0102
Mailing Address - Fax:
Practice Address - Street 1:1901 N HARRISON AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5597
Practice Address - Country:US
Practice Address - Phone:919-677-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool