Basic Information
| Provider Information | |||||||||
| NPI: | 1275914301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW, LCSW, LCASA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12721 DARBY BROOK CT STE 102 | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221922408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034971771 | ||||||||
| FaxNumber: | 7034971225 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 HAY ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104380939 | ||||||||
| FaxNumber: | 9104380942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C011257 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 23401 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 0904010502 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.