Healthcare Provider Details

I. General information

NPI: 1962615252
Provider Name (Legal Business Name): JOHN STEPHEN PARKER MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 ANNAND DR STE 20
WILMINGTON DE
19808
US

IV. Provider business mailing address

2601 ANNAND DR STE 20
WILMINGTON DE
19808-3719
US

V. Phone/Fax

Practice location:
  • Phone: 302-898-9861
  • Fax: 610-274-2209
Mailing address:
  • Phone: 302-898-9861
  • Fax: 610-274-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000439
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-006161-L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS-006161-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: