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General NPI Number Information
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NPI Number | 1851104582
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Entity Type | Individual
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Provider Name | JORDAN THOMAS PARKER LPC
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Gender | Male
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 4445 CORPORATION LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-3262
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Country | US
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Telephone | 757-233-0003
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Fax |
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Provider Business Mailing Address
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Address Line | 2900 EVERGREEN CT
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City | CHESAPEAKE
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State | VA
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Zip | 23321-4209
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Country | US
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Telephone | 757-572-4780
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701014455
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License Number State | VA
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