Provider Demographics
NPI:1356688758
Name:PARKS, MARY CHRISTINE (LCSW, LCAS, ICAADC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CHRISTINE
Last Name:PARKS
Suffix:
Gender:F
Credentials:LCSW, LCAS, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 WRIGHTSVILLE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6336
Mailing Address - Country:US
Mailing Address - Phone:910-622-7204
Mailing Address - Fax:910-401-1423
Practice Address - Street 1:4302 WRIGHTSVILLE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6336
Practice Address - Country:US
Practice Address - Phone:910-622-7204
Practice Address - Fax:910-401-1423
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1505101YA0400X
NCC0066231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)