Provider Demographics
NPI:1104143882
Name:PARKER, SHIRLEY (EDS)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-1561
Mailing Address - Country:US
Mailing Address - Phone:252-207-3837
Mailing Address - Fax:
Practice Address - Street 1:2224 S CROATAN HWY UNIT D
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8813
Practice Address - Country:US
Practice Address - Phone:252-207-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7152101Y00000X
NC1479101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)