Provider Demographics
NPI:1427651322
Name:PARKER, DESTINEE (C-MMT)
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:C-MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHAWAN RD UNIT 401
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1478
Mailing Address - Country:US
Mailing Address - Phone:443-801-9772
Mailing Address - Fax:
Practice Address - Street 1:100 SHAWAN RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1459
Practice Address - Country:US
Practice Address - Phone:443-801-9772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health