Provider Demographics
NPI:1114048824
Name:PARKS, KATHY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:PARKS BOYD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2911 ADAMS AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1509
Mailing Address - Country:US
Mailing Address - Phone:619-261-9269
Mailing Address - Fax:858-408-4485
Practice Address - Street 1:10992 SAN DIEGO MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2444
Practice Address - Country:US
Practice Address - Phone:619-641-4510
Practice Address - Fax:619-641-4417
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 102261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical