Provider Demographics
NPI:1740886720
Name:ANDERSON, PARKER REID (LCMHCA)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:REID
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-3580
Mailing Address - Country:US
Mailing Address - Phone:919-808-5620
Mailing Address - Fax:
Practice Address - Street 1:547 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-3580
Practice Address - Country:US
Practice Address - Phone:919-808-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health