Healthcare Provider Details

I. General information

NPI: 1982545869
Provider Name (Legal Business Name): TIMOTHY D PARENT LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 TREATMENT PLANT RD APT C4
MOREHEAD CITY NC
28557-3457
US

IV. Provider business mailing address

1034 TREATMENT PLANT RD APT C4
MOREHEAD CITY NC
28557-3457
US

V. Phone/Fax

Practice location:
  • Phone: 252-671-4857
  • Fax:
Mailing address:
  • Phone: 252-671-4857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28682
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: