Provider Demographics
NPI:1821242694
Name:PARKINSON, MARY DESONDE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:DESONDE
Last Name:PARKINSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 HINMAN AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2576
Mailing Address - Country:US
Mailing Address - Phone:847-864-2163
Mailing Address - Fax:
Practice Address - Street 1:738 HINMAN AVE
Practice Address - Street 2:UNIT G
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2576
Practice Address - Country:US
Practice Address - Phone:847-864-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health