Provider Demographics
NPI:1477985703
Name:PARKER, PATRICIA ANN (LCADC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23630 PUBLIC HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4324
Mailing Address - Country:US
Mailing Address - Phone:240-888-3613
Mailing Address - Fax:
Practice Address - Street 1:1400 E WEST HWY # OH
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3230
Practice Address - Country:US
Practice Address - Phone:301-919-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA1723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)