Provider Demographics
NPI:1689089377
Name:PARKER, WANDA (MA, CADC, LCPC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA, CADC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14710 CENTRAL AVE
Mailing Address - Street 2:APARTMENT C319
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1252
Mailing Address - Country:US
Mailing Address - Phone:773-575-9631
Mailing Address - Fax:
Practice Address - Street 1:14710 CENTRAL AVE
Practice Address - Street 2:APARTMENT C319
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1252
Practice Address - Country:US
Practice Address - Phone:773-575-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21216101YA0400X
101YM0800X
IL180.010540101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health