Provider Demographics
NPI:1154958601
Name:PARKER, JOSHUA (LPN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:PARKER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8832
Mailing Address - Country:US
Mailing Address - Phone:740-479-0067
Mailing Address - Fax:
Practice Address - Street 1:3014 CHAMPION DR
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9343
Practice Address - Country:US
Practice Address - Phone:740-479-0067
Practice Address - Fax:304-900-3629
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2382-2905101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2382-2905OtherBUSINESS LICENSE NUMBER