Provider Demographics
NPI:1114680949
Name:PARKS, SARAH MICHELE (AA, SUDPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELE
Last Name:PARKS
Suffix:
Gender:F
Credentials:AA, SUDPT
Other - Prefix:
Other - First Name:SAFRAH
Other - Middle Name:
Other - Last Name:GILSTRAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA, SUDPT
Mailing Address - Street 1:13020 NE 118TH WAY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2253
Mailing Address - Country:US
Mailing Address - Phone:503-798-0448
Mailing Address - Fax:
Practice Address - Street 1:12503 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4009
Practice Address - Country:US
Practice Address - Phone:360-314-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61154758101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)