Provider Demographics
NPI:1578944682
Name:PARKS, ROBIN IBRONKE (MA, NCC, LCPC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:IBRONKE
Last Name:PARKS
Suffix:
Gender:F
Credentials:MA, NCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16507 GOVERNOR BRIDGE RD
Mailing Address - Street 2:307
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3650
Mailing Address - Country:US
Mailing Address - Phone:703-638-4913
Mailing Address - Fax:
Practice Address - Street 1:16507 GOVERNOR BRIDGE RD
Practice Address - Street 2:307
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3650
Practice Address - Country:US
Practice Address - Phone:703-638-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNCC298949101YP2500X
MDLC6539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional