Provider Demographics
NPI:1134591449
Name:PARKER, SHAWN (CRC, LPC-A)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:CRC, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 QUAIL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-2944
Mailing Address - Country:US
Mailing Address - Phone:336-255-3513
Mailing Address - Fax:336-728-4355
Practice Address - Street 1:3007 QUAIL OAKS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-2944
Practice Address - Country:US
Practice Address - Phone:336-255-3513
Practice Address - Fax:336-728-4355
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health