Provider Demographics
NPI:1053690008
Name:PARKS, ANTIONETTE (MSW)
Entity Type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 PINEWAY
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1161
Mailing Address - Country:US
Mailing Address - Phone:240-505-3149
Mailing Address - Fax:
Practice Address - Street 1:9332 ANNAPOLIS RD
Practice Address - Street 2:SUITE # 217
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3113
Practice Address - Country:US
Practice Address - Phone:240-505-3149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD097541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical