Healthcare Provider Details

I. General information

NPI: 1003792409
Provider Name (Legal Business Name): ERNESHIA PARKER BA PSYCHOLOGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 REDWOOD WAY STE 210
PETALUMA CA
94954-1134
US

IV. Provider business mailing address

1301 REDWOOD WAY STE 210
PETALUMA CA
94954-1134
US

V. Phone/Fax

Practice location:
  • Phone: 707-806-9921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: