Provider Demographics
NPI:1689732265
Name:PARKS, ALECIA JOY (LMSW)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:JOY
Last Name:PARKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 W BURNS LINE RD
Mailing Address - Street 2:
Mailing Address - City:MELVIN
Mailing Address - State:MI
Mailing Address - Zip Code:48454-9802
Mailing Address - Country:US
Mailing Address - Phone:586-615-8991
Mailing Address - Fax:
Practice Address - Street 1:441 W BURNS LINE RD
Practice Address - Street 2:
Practice Address - City:MELVIN
Practice Address - State:MI
Practice Address - Zip Code:48454
Practice Address - Country:US
Practice Address - Phone:586-615-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010920791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical