Provider Demographics
NPI:1760607220
Name:PARKER, CAROLYN A (LCPC, LADC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STATE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5103
Mailing Address - Country:US
Mailing Address - Phone:207-992-2106
Mailing Address - Fax:
Practice Address - Street 1:15 STATE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5103
Practice Address - Country:US
Practice Address - Phone:207-992-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC740101YA0400X
MECC1902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)