Healthcare Provider Details

I. General information

NPI: 1154958601
Provider Name (Legal Business Name): JOSHUA PARKER LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 CHAMPION DR
BARBOURSVILLE WV
25504-9343
US

IV. Provider business mailing address

2984 COUNTY ROAD 1
SOUTH POINT OH
45680-8832
US

V. Phone/Fax

Practice location:
  • Phone: 740-479-0067
  • Fax: 304-900-3629
Mailing address:
  • Phone: 740-479-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2382-2905
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: