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General NPI Number Information
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NPI Number | 1124260898
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Entity Type | Individual
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Provider Name | TODD W PARKER CCJP
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Gender | Male
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 5060 SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27609-4428
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Country | US
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Telephone | 919-794-3382
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Fax | 919-794-3409
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Provider Business Mailing Address
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Address Line | 5060 SIX FORKS RD
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City | RALEIGH
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State | NC
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Zip | 27609-4428
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Country | US
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Telephone | 919-794-3382
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Fax | 919-794-3409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 213
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License Number State | NC
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