1285669309 NPI number — MR. JOSEPH PARKER NEW LPC

Table of content: MR. JOSEPH PARKER NEW LPC (NPI 1285669309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285669309 NPI number — MR. JOSEPH PARKER NEW LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEW
Provider First Name:
JOSEPH
Provider Middle Name:
PARKER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285669309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5361A VIRGINIA BEACH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-1897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-456-2366
Provider Business Mailing Address Fax Number:
757-456-2367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4855 PRINCESS ANNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23462-4446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-467-7707
Provider Business Practice Location Address Fax Number:
757-495-3206
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701003666 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010114951 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010114951 . This is a "VIRGINIA PREMIER HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 175532 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: O81171M . This is a "SENTARA/OPTIMA/OPTIMA FC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 251682 . This is a "COMPSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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