Healthcare Provider Details

I. General information

NPI: 1316769516
Provider Name (Legal Business Name): DRIESA LENE PARKER LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LAKE AVE
SPRING LAKE NC
28390-3937
US

IV. Provider business mailing address

7711 S RAEFORD RD STE 102-155
FAYETTEVILLE NC
28304-5986
US

V. Phone/Fax

Practice location:
  • Phone: 910-339-9375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP021429
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: