Provider Demographics
NPI:1720265713
Name:PARKER, LAQUEENA S (BS)
Entity type:Individual
Prefix:
First Name:LAQUEENA
Middle Name:S
Last Name:PARKER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BARTON CREEK DR APT J
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6429
Mailing Address - Country:US
Mailing Address - Phone:704-510-5146
Mailing Address - Fax:
Practice Address - Street 1:845 CHURCH ST N STE 305
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4375
Practice Address - Country:US
Practice Address - Phone:704-262-1320
Practice Address - Fax:704-262-1322
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health