Provider Demographics
NPI:1588326565
Name:PARKER, EBONE JAYSHAUNTA
Entity type:Individual
Prefix:
First Name:EBONE
Middle Name:JAYSHAUNTA
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EBONE
Other - Middle Name:JAYSHAUNTA
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 N ELIZABETH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-4081
Mailing Address - Country:US
Mailing Address - Phone:984-444-0688
Mailing Address - Fax:
Practice Address - Street 1:101 N ELIZABETH ST APT 1
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-4081
Practice Address - Country:US
Practice Address - Phone:984-444-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician