Provider Demographics
NPI:1174863146
Name:PARKER, KARL D (LCPC)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:D
Last Name:PARKER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2641
Mailing Address - Country:US
Mailing Address - Phone:207-730-3423
Mailing Address - Fax:207-871-7431
Practice Address - Street 1:713 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2641
Practice Address - Country:US
Practice Address - Phone:207-730-3423
Practice Address - Fax:207-871-7431
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional