Provider Demographics
NPI:1285819722
Name:PARKS, DAWN LORRAINE (CADAC II, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LORRAINE
Last Name:PARKS
Suffix:
Gender:F
Credentials:CADAC II, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E GROVE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2737
Mailing Address - Country:US
Mailing Address - Phone:800-273-6277
Mailing Address - Fax:888-978-4883
Practice Address - Street 1:165 E GROVE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-2737
Practice Address - Country:US
Practice Address - Phone:800-273-6277
Practice Address - Fax:888-978-4883
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1317AL101YA0400X
MA6530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA106723Medicaid