Healthcare Provider Details

I. General information

NPI: 1356725782
Provider Name (Legal Business Name): DEIRDRE PARKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 SOUTH D STREET SUITE 101
SAN BERNADINO CA
92408
US

IV. Provider business mailing address

1585 SOUTH D STREET SUITE 101
SAN BERNADINO CA
92408
US

V. Phone/Fax

Practice location:
  • Phone: 909-388-2222
  • Fax: 909-388-2220
Mailing address:
  • Phone: 909-388-2222
  • Fax: 909-388-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: