Provider Demographics
NPI:1649632449
Name:PARKER, CANDACE JANELLE (LCSW-A)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:JANELLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 MERIDIAN DR
Mailing Address - Street 2:APT.4
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5583
Mailing Address - Country:US
Mailing Address - Phone:919-356-0571
Mailing Address - Fax:
Practice Address - Street 1:401 MOYE BLVD.
Practice Address - Street 2:GREENVILLE VA HEALTH CARE CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5583
Practice Address - Country:US
Practice Address - Phone:252-830-2149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0090731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical