Provider Demographics
NPI:1316267966
Name:PARKER, AUDRY JOHNSON
Entity type:Individual
Prefix:MS
First Name:AUDRY
Middle Name:JOHNSON
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 1:510 HIGHWAY 64 W
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-3179
Mailing Address - Country:US
Mailing Address - Phone:828-837-6218
Mailing Address - Fax:828-837-1452
Practice Address - Street 1:510 HIGHWAY 64 W
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-3179
Practice Address - Country:US
Practice Address - Phone:828-837-6218
Practice Address - Fax:828-837-1452
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4364N101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor