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Individual

JUSTIN PARKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCAS-A, LCMHC-A

Contact information

Practice address
3512 VIRGINIA DARE TRL N, KITTY HAWK, NC 27949-4079
(252) 242-3900
Mailing address
3512 VIRGINIA DARE TRL N, KITTY HAWK, NC 27949-4079
(252) 242-3900

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-26586
NC
101YM0800X
Mental Health Counselor
A15964
NC

Other

Enumeration date
09/29/2020
Last updated
09/29/2020
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