Provider Demographics
NPI:1225338825
Name:PARKER, CAROLYN SUE (LPC, CDCT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPC, CDCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 CROYLE AVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8912
Mailing Address - Country:US
Mailing Address - Phone:605-209-6118
Mailing Address - Fax:
Practice Address - Street 1:7808 CROYLE AVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8912
Practice Address - Country:US
Practice Address - Phone:605-209-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC1102101Y00000X
SD5805101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)