Individual
CARRIE PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 OLIVE ST, LAWRENCEVILLE, IL 62439-2269
(618) 943-3451
Mailing address
PO BOX M, OLNEY, IL 62450-0913
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20150720643208
—
IL
Enumeration date
03/15/2018
Last updated
03/15/2018
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