Provider Demographics
NPI:1194360669
Name:PARKS, KATIE (PSYD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4927
Mailing Address - Country:US
Mailing Address - Phone:302-438-6050
Mailing Address - Fax:
Practice Address - Street 1:1275B W PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-4719
Practice Address - Country:US
Practice Address - Phone:410-620-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health