MEDICARE: LAKISHA PARKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-10-7084	VA

General Provider Information

NPI Number	:	1558676015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKISHA PARKER

Provider Business Mailing Address
First Line	:	101 LISBON CT
Second Line	:	APT 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3183
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 LISBON CT
Second Line	:	APT 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3183
Country	:	US
Telephone Number	:	757-615-3003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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Directions to “ LAKISHA PARKER ” Practice Location

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