Provider Demographics
NPI:1780273243
Name:PARKER, DEREK E (ABAT)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:E
Last Name:PARKER
Suffix:
Gender:M
Credentials:ABAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 SUNNYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4449
Mailing Address - Country:US
Mailing Address - Phone:973-380-7681
Mailing Address - Fax:919-937-2046
Practice Address - Street 1:615 WHEAT MILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1242
Practice Address - Country:US
Practice Address - Phone:252-452-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11327OtherQUALIFIED APPLIED BEHAVIOR ANALYSIS CREDENTIALING BOARD