Provider Demographics
NPI:1073850574
Name:PARKER, ANNEGELIQUE NICHOLE (MS, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ANNEGELIQUE
Middle Name:NICHOLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:MS
Other - First Name:ANNEGELIQUE
Other - Middle Name:NICHOLE
Other - Last Name:BLAKEY-BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:8401 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2036
Mailing Address - Country:US
Mailing Address - Phone:317-338-4600
Mailing Address - Fax:
Practice Address - Street 1:8401 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2036
Practice Address - Country:US
Practice Address - Phone:317-338-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003214A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor