Provider Demographics
NPI:1679112338
Name:SMITH-PARKER, LISA
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SMITH-PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 KETTERING DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1552
Mailing Address - Country:US
Mailing Address - Phone:301-357-4626
Mailing Address - Fax:
Practice Address - Street 1:422 KETTERING DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1552
Practice Address - Country:US
Practice Address - Phone:301-357-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-29
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9056101YS0200X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool