Provider Demographics
NPI:1992444129
Name:PARKER, KAYLEE CHARICE
Entity type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:CHARICE
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 1:120 E 5TH NORTH ST # 120A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6822
Mailing Address - Country:US
Mailing Address - Phone:843-460-2605
Mailing Address - Fax:
Practice Address - Street 1:120 E 5TH NORTH ST # 120A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6822
Practice Address - Country:US
Practice Address - Phone:843-460-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC105641210106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician