Provider Demographics
NPI:1598704330
Name:PARKS, EDWARD (LCSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:PARKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COASTAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-1974
Mailing Address - Country:US
Mailing Address - Phone:912-554-8500
Mailing Address - Fax:912-280-1523
Practice Address - Street 1:800 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4813
Practice Address - Country:US
Practice Address - Phone:912-790-6201
Practice Address - Fax:912-354-3036
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW003244104100000X
GACSW0037011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW003701OtherSTATE LICENSURE
GAMSW003244OtherSTATE LICENSE