Provider Demographics
NPI:1366867814
Name:PARKER, JACQUELINE FRANCES CURRIE (LCMHC)
Entity type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:FRANCES CURRIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 SILVERSMITH LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0869
Mailing Address - Country:US
Mailing Address - Phone:773-469-1576
Mailing Address - Fax:
Practice Address - Street 1:3555 N SHARON AMITY RD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-8993
Practice Address - Country:US
Practice Address - Phone:773-469-1576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10392101Y00000X, 101YP2500X, 103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC364543383Medicaid