Provider Demographics
NPI:1124260898
Name:PARKER, TODD W (CCJP)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:W
Last Name:PARKER
Suffix:
Gender:M
Credentials:CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4428
Mailing Address - Country:US
Mailing Address - Phone:919-794-3382
Mailing Address - Fax:919-794-3409
Practice Address - Street 1:5060 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4428
Practice Address - Country:US
Practice Address - Phone:919-794-3382
Practice Address - Fax:919-794-3409
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC213101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)