Provider Demographics
NPI:1063873990
Name:PARKER, KELLER
Entity type:Individual
Prefix:
First Name:KELLER
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 HEWITT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3028
Mailing Address - Country:US
Mailing Address - Phone:980-250-4861
Mailing Address - Fax:864-242-0700
Practice Address - Street 1:2320 E NORTH ST
Practice Address - Street 2:DD-103
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-1247
Practice Address - Country:US
Practice Address - Phone:864-239-6900
Practice Address - Fax:864-242-0700
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175T00000XOther Service ProvidersPeer Specialist