Provider Demographics
NPI:1790037026
Name:PARKER, MAGGIE (LPC)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:DR
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:MORGANFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:109 LANDRUM ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4723
Mailing Address - Country:US
Mailing Address - Phone:601-488-4631
Mailing Address - Fax:
Practice Address - Street 1:2906 N STATE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4233
Practice Address - Country:US
Practice Address - Phone:769-524-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1692101YM0800X
TX67206101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional